TY - JOUR
T1 - Antipsychotics for Parkinson's disease
T2 - a protocol for a systematic review with network meta-analysis and trial sequential analysis
AU - Petersen, Johanne Juul
AU - Kamp, Caroline Barkholt
AU - Juul, Sophie
AU - Bjerg, Jonas Leth
AU - Sillassen, Christina Dam Bjerregaard
AU - Faltermeier, Pascal
AU - Salvesen, Lisette
AU - Hejl, Anne Mette
AU - Bech, Sara
AU - Løkkegaard, Annemette
AU - Jakobsen, Janus C
N1 - © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/9/26
Y1 - 2025/9/26
N2 - INTRODUCTION: Parkinson's disease is a neurological disease with a rising incidence and prevalence. Patients with Parkinson's disease may receive antipsychotics, for example, due to Parkinson's disease psychosis. Parkinson's disease psychosis is characterised by visual hallucinations and other psychotic symptoms. To date, no systematic review has evaluated the effects of antipsychotics in patients with Parkinson's disease. Therefore, this review aims to assess the beneficial and harmful effects of antipsychotics for Parkinson's disease.METHODS AND ANALYSIS: This is a protocol for a systematic review. A search specialist will perform a search in major medical databases (eg, MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica database), CENTRAL (Cochrane Central Register of Controlled Trials)) and clinical trial registries. Published and unpublished randomised clinical trials comparing antipsychotics to any control (placebo, standard care or other antipsychotics) in patients with Parkinson's disease will be included. Two review authors will independently extract data and conduct risk of bias assessments with the Cochrane Risk of Bias tool-V.2. Primary outcomes will be all-cause mortality, serious adverse events and significant falls. Secondary outcomes will be hospitalisations, non-serious adverse events, Unified Parkinson's Disease Rating Scale total score and psychotic symptoms using any valid symptom scale. Data will be synthesised by aggregate meta-analysis, trial sequential analysis and network meta-analysis. Several subgroup analyses are planned. An eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by GRADE (Grading of Recommendations Assessment, Development and Evaluations) and CiNeMA (Confidence in Network Meta-Analysis) approach.ETHICS AND DISSEMINATION: This protocol does not include results, and ethics approval is not required for the project. The findings from the systematic review will be published in international peer-reviewed scientific journals.PROSPERO REGISTRATION NUMBER: PROSPERO ID: CRD42025633985. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633985.
AB - INTRODUCTION: Parkinson's disease is a neurological disease with a rising incidence and prevalence. Patients with Parkinson's disease may receive antipsychotics, for example, due to Parkinson's disease psychosis. Parkinson's disease psychosis is characterised by visual hallucinations and other psychotic symptoms. To date, no systematic review has evaluated the effects of antipsychotics in patients with Parkinson's disease. Therefore, this review aims to assess the beneficial and harmful effects of antipsychotics for Parkinson's disease.METHODS AND ANALYSIS: This is a protocol for a systematic review. A search specialist will perform a search in major medical databases (eg, MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica database), CENTRAL (Cochrane Central Register of Controlled Trials)) and clinical trial registries. Published and unpublished randomised clinical trials comparing antipsychotics to any control (placebo, standard care or other antipsychotics) in patients with Parkinson's disease will be included. Two review authors will independently extract data and conduct risk of bias assessments with the Cochrane Risk of Bias tool-V.2. Primary outcomes will be all-cause mortality, serious adverse events and significant falls. Secondary outcomes will be hospitalisations, non-serious adverse events, Unified Parkinson's Disease Rating Scale total score and psychotic symptoms using any valid symptom scale. Data will be synthesised by aggregate meta-analysis, trial sequential analysis and network meta-analysis. Several subgroup analyses are planned. An eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by GRADE (Grading of Recommendations Assessment, Development and Evaluations) and CiNeMA (Confidence in Network Meta-Analysis) approach.ETHICS AND DISSEMINATION: This protocol does not include results, and ethics approval is not required for the project. The findings from the systematic review will be published in international peer-reviewed scientific journals.PROSPERO REGISTRATION NUMBER: PROSPERO ID: CRD42025633985. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633985.
KW - Humans
KW - Systematic Reviews as Topic
KW - Parkinson Disease/drug therapy
KW - Antipsychotic Agents/therapeutic use
KW - Network Meta-Analysis as Topic
KW - Research Design
KW - Meta-Analysis as Topic
KW - Psychotic Disorders/drug therapy
KW - Parkinson-s disease
KW - Systematic Review
KW - Network Meta-Analysis
KW - Psychiatry
U2 - 10.1136/bmjopen-2025-098931
DO - 10.1136/bmjopen-2025-098931
M3 - Protocol
C2 - 41005778
SN - 2044-6055
VL - 15
JO - BMJ open
JF - BMJ open
IS - 9
M1 - e098931
ER -