By Chris Berrie
LISBON, Portugal -- January 26, 2009 -- There is no evidence at present that pharmacotherapy has significant benefits for patients with borderline personality disorder (BPD), although some agents show efficacy for distinct pathology facets, according to results of a meta-analysis of 27 randomised controlled trials (RCTs).
Based on these findings, pharmacotherapy for BPD should be aimed at predefined target symptoms, the study authors reported in their presentation here at the 17th European Congress of Psychiatry, organised by the European Psychiatric Association (EPA).
Jutta M. Stoffers, a PhD student in the Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg im Breisgau, Germany, conducted the study with researchers in the United Kingdom and Germany under the supervision of principal investigator Klaus Lieb, MD, Department of Psychiatry and Psychotherapy, University of Mainz Medical Centre, Mainz, Germany.
During her presentation on January 26, Stoffers explained, "Pharmacotherapy is widening in its use for the treatment of borderline personality disorders, but there is no clear evidence from randomised, controlled trials or up-to-date meta-analyses that shows which drugs work definitely."
In their systematic review and meta-analysis of RCTs, Stoffers and colleagues evaluated up-to-date evidence of drug treatments used for treatment of adult patients with BPD.
Their study enrolled adults receiving long-term treatment for BPD and associated pathologies and included comparisons with placebo or with other agents, or with treatments combining several agents.
Studies included in the analysis were required to have sufficient methodological quality and internal validity and to report on the various outcomes of total BPD severity, distinct BPD symptoms, associated pathologies, psychopathological burden, mental health status, and tolerability.
Initially, 2 reviewers scrutinised independently a total of 9,681 articles relating to published and unpublished trials, obtained primarily through MEDLINE, EMBASE, and CENTRAL databases. Of these, 51 articles were included in the meta-analysis, reporting on a total of 27 RCTs.
The articles were examined as standard mean differences for continuous outcomes and baseline-to-endpoint change data; risk ratios were calculated for dichotomous outcomes, and nonstandardised mean-change differences where necessary.
Comparisons with placebo included first- and second-generation antipsychotics, mood stabilisers, and antidepressants.
For the main findings, Stoffers said, "No single drug proved to be efficacious in the treatment of overall BPD severity, but we found some effects for distinct BPD core symptoms and also for associated psychopathologies." These were mainly seen for the mood stabilisers and second-generation antipsychotic agents.
Similar findings were seen for drug versus drug comparisons, with no drug showing greater efficacy than any other drug. Similarly, the limited number of trials evaluating drug combinations showed no additional benefits for any combinations tested to date.
"If you choose your treatment together with your patient, you can have a look at what the target symptoms are, to pick out your targets and choose the treatment," Stoffers said.
As well as suggesting mood stabilisers and second-generation antipsychotic agents as first-line treatments for BPD, she also stressed, "By now, SSRI [selective serotonin reuptake inhibitor] treatments have been recommended broadly, but at this level of evidence of RCTs, there is no evidence of efficacy of SSRI treatment, at all."
[Presentation title: Pharmacotherapy of Borderline Personality Disorder: A Meta-Analysis of Randomised Control Trials. Abstract PW01-02]
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