Allopurinol as add-on treatment for mania symptoms in bipolar disorder: Systematic review and meta-analysis of randomised controlled trials. (January 2017)

• Record Type: Journal Article
• Authors: Bartoli, Francesco; Crocamo, Cristina; Clerici, Massimo; Carrà, Giuseppe
• Is Part Of: British journal of psychiatry. Volume 210:Number 1(2017)
• Page Start: 10
• Page End: 15
• Publication Date: 2017-01
• Subjects: Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.bp.115.180281
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : Background: Since bipolar disorder seems to be associated with purinergic system dysfunction, allopurinol might be effective in treating symptoms of mania. Aims: To estimate the efficacy and tolerability of allopurinol as adjunctive treatment for mania symptoms in people with bipolar affective disorder. Method: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effects of adjunctive allopurinol and placebo on mania symptom changes. Results: Five RCTs were included in the meta-analysis. Participants with allopurinol augmentation had a significantly greater decrease in mania symptoms than those with placebo (SMD= −0.34, P = 0.007), especially in people with the most severe forms of mania. Remission rates, although based on only two studies ( n = 177), were significantly higher among individuals receiving allopurinol, whereas for discontinuation and side-effects no difference was found. Conclusions: Our finding of a small to moderate effect size and overall low evidence for add-on allopurinol in reducing mania symptoms indicate that its use in routine practice needs further elucidation.