First-generation antipsychotic long-acting injections <i>v</i>. oral antipsychotics in schizophrenia: Systematic review of randomised controlled trials and observational studies

Haddad, Peter M.; Taylor, Mark; Niaz, Omair

doi:10.1192/bjp.195.52.s20

Cited by 98 publications

(82 citation statements)

References 51 publications

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“…Therefore, long-acting depot formulations are often recommended for individuals who are known to have patterns of nonadherence to oral antipsychotic medication. 5,6 However, the findings in the clinical literature regarding the comparative effectiveness of depot versus oral antipsychotics in schizophrenia have been inconsistent. [7][8][9] These findings have challenged the field to consider the proper role of long-acting depot therapy.…”

mentioning

confidence: 99%

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Kirson¹,

Weiden²,

Yermakov³

et al. 2013

J. Clin. Psychiatry

163

128

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Objective: Nonadherence is a major challenge in schizophrenia treatment. While long-acting (depot) antipsychotic medications are often recommended to address adherence problems, evidence on the comparative effectiveness of depot versus oral antipsychotics is inconsistent. We hypothesize that this inconsistency could be due to systematic differences in study design. This review evaluates the effect of study design on the comparative effectiveness of antipsychotic formulations. The optimal use of different antipsychotic formulations in a general clinical setting depends on better understanding of the underlying reasons for differences in effectiveness across research designs.Data Sources: A PubMed literature review targeted English-language studies (2000-2011) with information on relapse, hospitalization, or allcause discontinuation for depot and oral antipsychotic treatment arms in schizophrenia. The time frame was chosen to reflect research focused on the newer generation of antipsychotic agents. The search required at least 1 term from each of the following categories: (1) schizophrenia; (2) inject, injection, injectable, injectables, injected, depot, long-acting; and (3) iloperidone, fluphenazine, haloperidol, paliperidone, risperidone, olanzapine, asenapine, flupentixol, flupenthixol, lurasidone, clopenthixol, fluspirilene, zuclopentixol, zuclopenthixol. Study Selection: Thirteen relevant studies were identified by 2 independent reviewers; these studies included information on 19 depot-oral comparisons.Data Extraction: Age-and gender-adjusted risk ratios (RRs) (depot/ oral) were calculated for the identified endpoints and pooled by study design (randomized controlled trial [RCT], prospective observational, and retrospective observational). Meta-analysis with random effects was used to estimate the pooled RRs, by study design. Average conversion factors between study designs were calculated as the ratios of pooled RRs.Results: Meta-analysis of adjusted endpoints showed no apparent benefit of depot over oral formulations in RCTs, with an RR of 0.89 (P = .416). In contrast, there was a significant advantage for depot formulations in other study designs (prospective RR = 0.62 [P < .001]; retrospective RR = 0.56 [P < .001]). These imply conversion factors of 1.43 and 1.59 between RCTs and prospective and retrospective designs, respectively. Conclusions:The comparative effectiveness of antipsychotic formulations is sensitive to research design. Depot formulations displayed significant advantages in nonrandomized observational studies, whereas in RCTs no difference was observed. The estimated conversion factors may facilitate comparison across studies.

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mentioning

confidence: 99%

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Kirson¹,

Weiden²,

Yermakov³

et al. 2013

J. Clin. Psychiatry

163

128

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“…6 Observational studies demonstrate many benefits of long-acting injectable medications, such as reducing total number of days in the hospital and better functional outcomes. 7,8 Long-acting injectable antipsychotics are not often prescribed in patients with FEP 9 despite high nonadherence rates for oral medications and concurrent relapse of psychosis 10 (this is likely due to stigma associated with long acting injectable medications, as they are often seen as treatment of last resort).…”

Section: Discussionmentioning

confidence: 99%

Assessment and Treatment of Early-Stage Schizophrenia

O’Sullivan¹

2015

Psychiatric Annals

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“…In 2009 a systematic review of evidence comparing FGA oral antipsychotics and FGA LAIs by Haddad et al proved inconclusive, with contradictory evidence found during review. 8 Adams et al in a 2001 meta-analysis of RCTs showed no difference in relapse or tolerability between oral and LAI FGAs. 8,9 Very few direct comparisons of first-and second-generation LAIs exist.…”

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confidence: 99%

“…8 Adams et al in a 2001 meta-analysis of RCTs showed no difference in relapse or tolerability between oral and LAI FGAs. 8,9 Very few direct comparisons of first-and second-generation LAIs exist. Those that have been published continue to suggest that the differences are less clear than those proposed when SGAs were brought to market.…”

mentioning

confidence: 99%

Factors important to psychiatrists when prescribing depot antipsychotics

Kenicer¹,

Ellahi²,

Davies³

et al. 2016

Prog. Neurol. Psychiatry

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The relative benefits and disadvantages of first‐generation antipsychotics (FGAs) and second‐generation antipsychotics (SGAs) has been an area of much interest since SGAs were introduced amidst high expectations of superior efficacy and improved side‐effect profiles. In this article, Dr Kenicer et al. analyse a survey of psychiatrists to establish trends in prescribing preferences and the factors influencing them when prescribing antipsychotics. A key finding highlighted the need for an evidence based algorithm when prescribing these antipsychotics.

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First-generation antipsychotic long-acting injections v. oral antipsychotics in schizophrenia: Systematic review of randomised controlled trials and observational studies

Cited by 98 publications

References 51 publications

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Assessment and Treatment of Early-Stage Schizophrenia

Factors important to psychiatrists when prescribing depot antipsychotics

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