Efficacy and safety of quetiapine prophylaxis for delirium in hospitalized adult patients: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE

We aimed to compare summary estimates of efficacy and safety of quetiapine versus comparator treatments in preventing delirium among hospitalized adult patients by pooling evidence from parallel-group randomized controlled trials (RCTs).

METHODS

We searched MEDLINE, Embase, Scopus, and clinical trial registers from inception till January 31st, 2025. Our primary outcome was between-group incidence of delirium. Secondary outcomes included 10-day mortality, duration of hospital stay, duration of delirium, severity of delirium, readmission rates (efficacy outcomes), and reported adverse effects (safety outcomes).

RESULTS

Six eligible RCTs (pooled N = 491) were identified; of these, five were included in the meta-analysis. The pooled RR for preventing the incidence of delirium was 0.61 (95 % CI, 0.45-0.83;5 RCTs; I2 = 0;p = .001), favoring quetiapine (dose range 12.5-75 mg/day). The SMD for duration of delirium was -1.21 (95 % CI, -2.08 to -0.35; 3 RCTs; I2 = 86 %; p = .006), again favoring quetiapine. No significant between-group differences were noted on other outcomes. Adverse effects with quetiapine were absent in four studies and minimal in the other two. The findings were robust to sensitivity analyses.

CONCLUSION

Low-dose quetiapine prophylaxis may be a safe and effective treatment option for preventing delirium. These conclusions are tempered by the small number and size of existing trials.