Long-acting injectable antipsychotics for the prevention of relapse in patients with recent-onset psychotic disorders: A systematic review and meta-analysis of randomized controlled trials

• Published in: Psychiatry research 2016-12, Vol.246, p.750-755
• Main Authors: Kishi, Taro, Oya, Kazuto, Iwata, Nakao
• Format: Article
• Language: English
• Subjects: Antipsychotic Agents - administration & dosage; Antipsychotic Agents - pharmacology; Delayed-Action Preparations - administration & dosage; Delayed-Action Preparations - pharmacology; Humans; Long-acting injectable antipsychotics; Meta-analysis; Psychiatry; Psychotic Disorders - drug therapy; Randomized Controlled Trials as Topic - statistics & numerical data; Recent-onset psychotic disorders; Relapse rate; Schizophrenia - drug therapy; Secondary Prevention; Systematic review
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2016.10.053

Abstract This meta-analysis of randomized controlled trials (RCTs) investigated the advantages of long-acting injectable antipsychotics (LAI-APs) over oral antipsychotics (OAPs) with regard to efficacy and safety for patients with recent-onset psychotic disorders. Effect sizes and 95% confidence intervals (95%CIs) were calculated. We identified five RCTs (1022 patients, mean study duration=18±7.59 months) that compared LAI-APs (paliperidone or risperidone) with OAPs. Pooled LAI-APs did not outperform OAPs in terms of the preventing of relapse (N=3, n=875). However, there was significant heterogeneity (I2 =76%), with one study showing no superiority of LAI-APs over OAPs [Malla 2013: risk ratio (RR)=1.83, 95%CI=0.70–4.77, n=77] and the other two studies showing LAI-APs to be superior [Schreiner 2015: [RR=0.71, 95%CI=0.51–0.97, number needed to treat (NNT)=−17, n=715, Subotnik 2015: RR=0.15, 95%CI=0.04–0.63, NNT=−4, n=83]. Pooling the studies, there were no significant differences between LAI-APs and OAPs in the improvement of Positive and Negative Syndrome Scale scores or in discontinuation due to all-cause, adverse events (AEs), and death, but LAI-APs outperformed OAPs in terms of discontinuation due to inefficacy (RR=0.34, NNT=−50) and nonadherence (RR=0.30, NNT=−33). However, the LAI-APs were associated with a higher incidence of at least one AE (RR=1.13) and tremor (RR=2.38) compared with OAPs.