Overview of systematic reviews and meta-analysis of risperidone on cardiovascular risk: analysis of Cochrane and non-Cochrane systematic reviews including 11,949 patients.

OBJECTIVE

To evaluate the effects of risperidone on cardiovascular risk.

METHOD: The searches were completed by means of EMBASE, MEDLINE/PubMed (by the National Library of Medicine), Scopus, and Web of Science databases. We included SRs of risperidone and cardiovascular risk published up to 2022. PRISMA was enforced for reporting quality, AMSTAR 2 was used to assess methodological quality, and GRADE was executed for quality of evidence analysis.

RESULTS

After excluding 1883 publications, we identified six systematic reviews, which reported effect estimates with substantial uncertainty for tachycardia events (RR 1.35, 95% CI 0.87 to 2.10), QTc prolongation events (RR 1.02, 95% CI 0.94 to 1.10), and QTc prolongation as a continuous outcome (mean difference +9.39 ms, 95% CI 4.09 to 14.69). For systolic and diastolic blood pressure, extractable mean differences (mmHg) were not reported, limiting quantitative interpretation. Overall certainty of evidence ranged from low to very low. No SR entirely adhered to the PRISMA statement, AMSTAR 2 and GRADE suggested low to very low quality.

CONCLUSION

The available evidence from systematic reviews is of low to very low certainty and indicates substantial uncertainty regarding the cardiovascular effects of risperidone. Higher-quality systematic reviews with improved reporting and methodology are required.