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Objectives <p>The aim of this study is to indirectly compare and rank the different drugs that have been studied in randomized clinical trials (RCTs) in patients with tardive dyskinesia (TD) in terms of their efficacy in ameliorating the symptoms of TD and safety.</p> Design <p>A network meta-analysis and a systematic review was registered prospectively on PROSPERO under the ID: CRD42023407823 and was conducted in accordance with the PRISMA-NMA guidelines.</p> Data sources <p>PubMed, Scopus, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Clinicaltrials.gov were searched to identify relevant records.</p> Eligibility criteria for selecting studies <p>Any parallel randomized blinded controlled clinical trials that studied the use of any medications in treating TD and assessed the symptoms using a functional scale that has been previously validated.</p> Data extraction <p>The standardized mean difference of improvement along with the reported adverse events for each drug were extracted from each trial and a network meta-analysis was conducted using a random-effects model.</p> Results <p>One thousand eight hundred seventeen patients in 33 RCTs were included in the analysis. Twenty-three different drugs were compared to placebo in terms of reduction in TD symptoms. Among these, Insulin (SMD = -2.16, 95%CI = [ -3.62; -0.69]), vitamin E (-1.18, [-1.69; -0.68]), and valbenazine 80&#xa0;mg (SMD = -0.77, 95%CI = [ -1.48; -0.07]) significantly reduced TD symptoms in comparison to placebo, while deutetrabenazine 36&#xa0;mg (-0.53, [-1.52; 0.47]) and reserpine (-0.97, [-2.29; 0.36]) were not found to be significant in reducing the symptoms. Some serious adverse events were reported for valbenazine and deutetrabenazine, which included mainly psychiatric symptoms such as depression, worsening of schizophrenia and suicidal ideation, while mild adverse events were reported for other drugs, their incidence in the treatment arms were comparable to those in the placebo arm.</p> Conclusions <p>Low-certainty evidence suggests that insulin, vitamin E, and valbenazine 80&#xa0;mg may reduce TD symptoms. However, the significant side effects of valbenazine should prompt further investigation of alternative treatment modalities.</p>

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Efficacy and safety of different pharmacological interventions in the treatment of tardive dyskinesia: a systematic review and network meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月15日

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  • Omar Ismail,
  • Karam Albdour,
  • Yazan Jaber,
  • Kamel Jaber,
  • Ameen Alsaras

摘要

Objectives

The aim of this study is to indirectly compare and rank the different drugs that have been studied in randomized clinical trials (RCTs) in patients with tardive dyskinesia (TD) in terms of their efficacy in ameliorating the symptoms of TD and safety.

Design

A network meta-analysis and a systematic review was registered prospectively on PROSPERO under the ID: CRD42023407823 and was conducted in accordance with the PRISMA-NMA guidelines.

Data sources

PubMed, Scopus, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Clinicaltrials.gov were searched to identify relevant records.

Eligibility criteria for selecting studies

Any parallel randomized blinded controlled clinical trials that studied the use of any medications in treating TD and assessed the symptoms using a functional scale that has been previously validated.

Data extraction

The standardized mean difference of improvement along with the reported adverse events for each drug were extracted from each trial and a network meta-analysis was conducted using a random-effects model.

Results

One thousand eight hundred seventeen patients in 33 RCTs were included in the analysis. Twenty-three different drugs were compared to placebo in terms of reduction in TD symptoms. Among these, Insulin (SMD = -2.16, 95%CI = [ -3.62; -0.69]), vitamin E (-1.18, [-1.69; -0.68]), and valbenazine 80 mg (SMD = -0.77, 95%CI = [ -1.48; -0.07]) significantly reduced TD symptoms in comparison to placebo, while deutetrabenazine 36 mg (-0.53, [-1.52; 0.47]) and reserpine (-0.97, [-2.29; 0.36]) were not found to be significant in reducing the symptoms. Some serious adverse events were reported for valbenazine and deutetrabenazine, which included mainly psychiatric symptoms such as depression, worsening of schizophrenia and suicidal ideation, while mild adverse events were reported for other drugs, their incidence in the treatment arms were comparable to those in the placebo arm.

Conclusions

Low-certainty evidence suggests that insulin, vitamin E, and valbenazine 80 mg may reduce TD symptoms. However, the significant side effects of valbenazine should prompt further investigation of alternative treatment modalities.