Efficacy and safety of anti-inflammatory drug-assisted treatment of symptoms in patients with schizophrenia: a meta-analysis
Abstract
BACKGROUND: Although anti-inflammatory agents have been explored as adjunctive treatments for schizophrenia, findings remain inconsistent. While some meta-analyses suggest benefit, concerns persist regarding methodological heterogeneity, language bias, and the influence of publication bias on reported effect sizes (ES). This updated meta-analysis aims to re-evaluate the efficacy and safety of anti-inflammatory drugs in schizophrenia, with a critical focus on robustness after accounting for these biases. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating anti-inflammatory drugs as adjunctive therapy in schizophrenia. Databases (PubMed, Embase, Scopus, Web of Science) were searched from inception to December 31, 2024, with restriction to English-language publications. Standardized mean differences (Hedges’s g) were calculated using a random-effects model. Heterogeneity was assessed using I², and publication bias was evaluated via Egger’s test and trim-and-fill analysis. Sensitivity analyses were performed to assess robustness. RESULTS: Seventy-four RCTs involving 5,484 participants were included. Initial analyses suggested significant benefits for aspirin (ES = 0.64), celecoxib (ES = 0.49), estrogens (ES = 0.59), fatty acids (ES = 0.25), minocycline (ES = 0.38), N-acetylcysteine (NAC; ES = 0.60), monoclonal antibodies (mAbs; ES = 0.49), and pregnenolone (ES = 0.20). However, substantial heterogeneity (I² > 50%) and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,484 participants or records.
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