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- Dokumenttyp:
- Journal Article; Meta-Analysis
- Autor(en):
- Kishimoto, Taishiro; Robenzadeh, Alfred; Leucht, Claudia; Leucht, Stefan; Watanabe, Koichiro; Mimura, Masaru; Borenstein, Michael; Kane, John M; Correll, Christoph U
- Titel:
- Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials.
- Abstract:
- While long-acting injectable antipsychotics (LAIs) are hoped to reduce high relapse rates in schizophrenia, recent randomized controlled trials (RCTs) challenged the benefits of LAIs over oral antipsychotics (OAPs).Systematic review/meta-analysis of RCTs that lasted >= 6 months comparing LAIs and OAPs. Primary outcome was study-defined relapse at the longest time point; secondary outcomes included relapse at 3, 6, 12, 18, and 24 months, all-cause discontinuation, discontinuation due to adverse events, drug inefficacy (ie, relapse + discontinuation due to inefficacy), hospitalization, and nonadherence.Across 21 RCTs (n = 5176), LAIs were similar to OAPs for relapse prevention at the longest time point (studies = 21, n = 4950, relative risk [RR] = 0.93, 95% confidence interval [CI]: 0.80-1.08, P = .35). The finding was confirmed restricting the analysis to outpatient studies lasting >= 1 year (studies = 12, RR = 0.93, 95% CI:0.71-1.07, P = .31). However, studies using first-generation antipsychotic (FGA)-LAIs (studies = 10, RR = 0.82, 95% CI:0.69-0.97, P = .02) and those published <= 1991 (consisting exclusively of all 8 fluphenazine-LAI studies; RR = 0.79, 95% CI: 0.65-0.96, P = 0.02) were superior to OAPs regarding the primary outcome. Pooled LAIs also did not separate from OAPs regarding any secondary outcomes. Again, studies using FGA-LAIs and those published <= 1991 were associated with LAI superiority over OAPs, eg, hospitalization and drug inefficacy.In RCTs, which are less representative of real-world patients than naturalistic studies, pooled LAIs did not reduce relapse compared with OAPs in schizophrenia patients. The exceptions were FGA-LAIs, mostly consisting of fluphenazine-LAI studies, which were all conducted through 1991. Because this finding is vulnerable to a cohort bias, studies comparing FGA-LAI vs second-generation antipsychotics-LAI and LAI vs OAP RCTs in real-world patients are needed.
- Zeitschriftentitel:
- Schizophr Bull
- Jahr:
- 2014
- Band / Volume:
- 40
- Heft / Issue:
- 1
- Seitenangaben Beitrag:
- 192-213
- Sprache:
- eng
- Volltext / DOI:
- doi:10.1093/schbul/sbs150
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/23256986
- Print-ISSN:
- 0586-7614
- TUM Einrichtung:
- Klinik und Poliklinik für Psychiatrie und Psychotherapie
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