Acute Schizophrenia: Which Antipsychotics Are Most Effective and Tolerable?

<jats:p>A network meta-analysis of 388 RCTs found clinically meaningful efficacy and tolerability differences among antipsychotics for acute schizophrenia. Clozapine, amisulpride, olanzapine, and risperidone ranked broadly higher for efficacy. Xanomeline/trospium ranked well, but without direct head-to-head comparisons. Lumateperone showed few side effects but ranked last in efficacy. Meta-analytic rankings cannot replace shared decision-making. The best antipsychotic is the one the patient accepts after weighing benefit, burden, and dose. For first-episode patients, side effects may matter more than efficacy rankings.</jats:p>