Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis

Abstract

We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine D2 antagonism-related symptoms.

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies

“…Long-acting antipsychotics are associated with an increased adherence compared to oral antipsychotics [ 69 ], and consequently to a greater exposure to these drugs that in turn could be associated with a greater risk of metabolic side effects. Supporting this hypothesis, it has been reported that, compared to oral SGAs, long-acting injectable SGAs are associated with a greater risk of some adverse events, such as extrapyramidal and prolactin-related symptoms [ 70 , 71 ], and some metabolic disorders, such as changes in LDL cholesterol [ 72 ]. Despite the benefits of long-acting injectable SGAs [ 73 ], it is important to know the metabolic risk associated with these formulations to facilitate the rational use of these compounds.…”

The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data?

“…11 Compared to oral agents, LA injectable antipsychotics are associated with lower risk of relapse, fewer hospitalizations, and greater retention on therapy. [11][12][13] In addition, one study found that individuals who were nonadherent to oral antipsychotics were less likely to discontinue LA therapy (p ¼ 0.033) compared with patients on oral therapy. 14 Building upon success in these disease states, LA antiretrovirals are currently being developed for the treatment and prevention of HIV infection.…”

The effect of long‐acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta‐analysis

“…2014; Park et al . 2018). Furthermore, no review to date, as far as we know, has incorporated social functioning as a main outcome.…”