Biperiden 2mg tablets

ImportanceAntipsychotic-induced akathisia (AIA) occurs in 14% to 35% of patients treated with antipsychotics and is associated with increased suicide and decreased adherence in patients with schizophrenia. However, no comprehensive review and network meta-analysis has been conducted to compare the efficacy of treatments for AIA.ObjectiveTo compare the efficacy associated with AIA treatments.Data sourcesThree databases (MEDLINE, Web of Science, and Google Scholar) were systematically searched by multiple researchers for double-blind randomized clinical trials (RCTs) comparing active drugs for the treatment of AIA with placebo or another treatment between May 30 and June 18, 2023.Study selectionSelected studies were RCTs that compared adjunctive drugs for AIA vs placebo or adjunctive treatment in patients treated with antipsychotics fulfilling the criteria for akathisia, RCTs with sample size of 10 patients or more, only trials in which no additional drugs were administered during the study, and RCTs that used a validated akathisia score. Trials with missing data for the main outcome (akathisia score at the end points) were excluded.Data extraction and synthesisData extraction and synthesis were performed, estimating standardized mean differences (SMDs) through pairwise and network meta-analysis with a random-effects model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed.Main outcomes and measuresThe primary outcome was the severity of akathisia measured by a validated scale at the last available end point.ResultsFifteen trials involving 492 participants compared 10 treatments with placebo. Mirtazapine (15 mg/d for ≥5 days; SMD, -1.20; 95% CI, -1.83 to -0.58), biperiden (6 mg/d for ≥14 days; SMD, -1.01; 95% CI, -1.69 to -0.34), vitamin B6 (600-1200 mg/d for ≥5 days; SMD, -0.92; 95% CI, -1.57 to -0.26), trazodone (50 mg/d for ≥5 days; SMD, -0.84; 95% CI, -1.54 to -0.14), mianserin (15 mg/d for ≥5 days; SMD, -0.81; 95% CI, -1.44 to -0.19), and propranolol (20 mg/d for ≥6 days; SMD, -0.78; 95% CI, -1.35 to -0.22) were associated with greater efficacy than placebo, with low to moderate heterogeneity (I2 = 34.6%; 95% CI, 0.0%-71.1%). Cyproheptadine, clonazepam, zolmitriptan, and valproate did not yield significant effects. Eight trials were rated as having low risk of bias; 2, moderate risk; and 5, high risk. Sensitivity analyses generally confirmed the results for all drugs except for cyproheptadine and propranolol. No association between effect sizes and psychotic severity was found.Conclusions and relevanceIn this systematic review and network meta-analysis, mirtazapine, biperiden, and vitamin B6 were associated with the greatest efficacy for AIA, with vitamin B6 having the best efficacy and tolerance profile. Trazodone, mianserin, and propranolol appeared as effective alternatives with slightly less favorable efficacy and tolerance profiles. These findings should assist prescribers in selecting an appropriate medication for treating AIA.

Abstract licence: CC BY

BackgroundTraumatic brain injury (TBI) is a leading cause of disability, with post-traumatic epilepsy (PTE) being a major complication. Biperiden has shown experimental potential in preventing epileptogenesis, however its impact on outcomes, such as quality of life (QoL), remains unknown. This study evaluated long-term QoL in TBI survivors treated with biperiden and identified clinical and socioeconomic predictors of their QoL.MethodsWe analyzed QoL data from a randomized, double-blind, placebo-controlled trial involving 48 adults with moderate to severe TBI, assessed on average 32 months post-injury. QoL was measured using the EQ-5D-3 L questionnaire. A cross-sectional analysis identified predictors of QoL using Generalized Linear Models (GLMs), and a longitudinal analysis of a 14-participant subgroup assessed changes over time using a paired t-test.ResultsEarly treatment with biperiden did not significantly alter QoL compared to placebo. However, the study identified significant negative predictors for QoL: the presence of PTE (β = -0.23, p = 0.02), temporal lobe lesion (β = -0.22, p = 0.006), and being a beneficiary (p = 0.002). QoL scores significantly improved between 11.6 months (0.457) and 27.1 months (0.678) post-TBI (p = 0.004). Descriptively, while mobility and self-care were well-preserved, the anxiety/depression dimension was the most affected dimension, with 22.5% of participants reporting extreme problems.ConclusionsBiperiden did not impact QoL in TBI survivors. However, improvements were observed in the approximately 2 years following injury. Predictors like PTE, temporal lesions and receiving benefits as income were associated with lower Qol score. These preliminary findings guide future interventions for TBI patients and are particularly important as they fill a data gap for the Brazilian population.Trial registrationThe trial was registered at ClinicalTrials.gov, a database managed by the U.S. National Library of Medicine (NLM) and National Institutes of Health (NIH), under the identifier NCT01048138 on January 13, 2010.

Abstract licence: CC BY-NC-ND

BACKGROUND: Traumatic brain injury (TBI) is one of the most important causes of acquired structural epilepsy, post-traumatic epilepsy (PTE), however, efficient preventative measures and treatment are still not available to patients. Preclinical studies indicated biperiden, an anticholinergic drug, as a potential drug to modify the epileptogenic process. The main objective of this clinical trial is to evaluate the efficacy of biperiden as an antiepileptogenic agent in patients that suffered TBI. METHODS: This prospective multicenter (n = 10) interventional study will include 312 adult patients admitted to emergency care units with a diagnosis of moderate or severe TBI. Following inclusion and exclusion criteria, patients will be randomized, using block randomization, to receive double-blind treatment with placebo or biperiden for 10 days. Follow-up will occur at specific time windows up to 2 years. Main outcomes are incidence of PTE after TBI and occurrence of severe adverse events. Other outcomes include exploratory investigation of factors that might have benefits for the treatment or might influence its results, such as genetic background, clinical progression, electroencephalographic abnormalities, health-related quality of life and neuropsychological status. Analyses will be conducted following the safety, intention-to-treat and efficacy concepts. DISCUSSION: We hypothesize that biperiden treatment will be effective to prevent or mitigate the development of post-traumatic epilepsy in TBI patients. Other health measures from this population also may benefit from treatment with biperiden. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04945213. Registered on June 30, 2021.

Abstract licence: CC BY 4.0