Efficacy And Safety Of Atypical Antipsychotics And Haloperidol For Delirium

Objective:Evaluate the efficacy and safety of atypical antipsychotics and haloperidol in treating delirium.Methods:Randomized controlled trials of delirium treatment using atypical antipsychotics and haloperidol were identified in CINAHL,CENTRAL,PsycINFO,Embase,WHO ICTRP,Pubmed,Cochrane Library,CNKI,Wanfang,VIP,CHiCTR and CBM by 10/10 2018.Response rates,all-cause mortality,incidence of anticholinergic-agent explosion and prolonged QTc were compared by calculating the risk ratio（RR）with the number needed to treat for an additional beneficial/harmful outcome（NNTB/H）,while standard mean differences（SMDs）were calculated with Cohen’s d to evaluate delirium severity and response time.Results:In 41 pooled studies included in this analysis(average study duration:9.07 days,total number of subjects:3379,n_aripiprazole=44,n_amisulpride=20,n_olanzapine=650,nhaloperidol=1138,nrisperidone=298,nquetiapine=314,nplacebo=227,nroutine treatment=398,haloperidol treatment produced a superior response rate（NNTB=3,RR=2.500）,greater relief of symptom severity（Cohen’s d=1.6,SMD=-1.55）and faster time to response（Cohen’s d=0.8,SMD=-0.79）compared with placebo/routine treatment.Similarly,olanzapine treatment improved response rates（NNTB=2,RR=2.88）,symptom severity（Cohen’s d=2.4,SMD=-2.36）and response time（Cohen’s d=2.4,SMD=-2.40）.In addition,with olanzapine treatment,time to response（Cohen’s d=1.2,SMD=-1.25）and the use of anticholinergic agents（NNTH=8,RR=0.03）were less than haloperidol.Evidence from this meta-analysis was rated as‘high’following the GRADE system.Conclusion:Both haloperidol and olanzapine can be used to treat delirium of inpatients safely and effectively,and patients taking the latter had a shorter time to response and a lower incidence of anticholinergic side effects.Other atypical antipsychotics need more placebo/routine treatment control.