Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

BMC Psychiatry

Table 4 GRADE table for APP compared to Antipsychotic monotherapy for metabolic effects in schizophrenia

GRADE assessment
Outcome	№ of reviews	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	GRADE Quality rating
Metabolic syndrome	2	Serious^a	Serious^b	Serious^b	Serious^b	Publication bias strongly suspected^c	⊕◯◯◯ VERY LOW
Lipid disorder	8	Serious^a	Not serious	Serious^d	Serious^e	Publication bias strongly suspected^f	⊕◯◯◯ VERY LOW
Diabetes	3	Serious^a	Serious^g	Serious^d	Serious^e	Publication bias strongly suspected strong association^h	⊕◯◯◯ VERY LOW
Hypertension	1	Serious^a	Not serious	Not serious	Serious^e	Publication bias strongly suspectedⁱ	⊕◯◯◯ VERY LOW

Explanations
^aAll included reviews were low quality based on AMSTAR. Not all reviews included RCTs alone, and not all performed quality assessment of the included studies. Primary studies were short term, small and often uncontrolled
^bOnly one review reported findings but without data on direct comparison
^cNone of the two reviews searched for unpublished studies or assessed publication bias
^dReviews used various comparisons (before and after; one time prevalence; specific combinations of antipsychotic versus any antipsychotic)
^eWide confidence intervals and/or ranges
^fOnly two reviews searched for unpublished studies and none assessed publication bias
^gReview findings were contrasting
^hOnly one review searched for unpublished studies. None assessed publication bias
ⁱOnly one review reported on this outcome which did not report a search for unpublished studies nor assessed publication bias for this outcome
Grade evidence levels
High = Further research is very unlikely to change our confidence in the estimate of effect
Moderate = Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low = Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low = Any estimate of effect is very uncertain

ISSN: 1471-244X