Comparative Efficacy and Safety of Long-Acting Injectable and Oral Second-Generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-Analysis
Seon-Cheol Park 1, Mi Young Choi 2, Jina Choi 2, Ha Jin Tchoe 2, Jae Kyung Suh 2, Young Hoon Kim 3, Seung Hee Won 4, Young-Chul Chung 5, Kyung-Yeol Bae 6, Sang-Kyu Lee 7, Chan Mi Park 2, Seung-Hwan Lee 8*
1Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, 2National Evidence-based Healthcare Collaborating Agency, Seoul, 3Department of Psychiatry, Gong-ju National Hospital, Gongju, 4Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, 5Department of Psychiatry, Chonbuk National University Hospital, Jeonju, 6Department of Psychiatry, Chonnam National University Medical School, Gwangju, 7Department of Psychiatry, Hallym University Chuncheon Sacred Hospital, College of Medicine, Hallym University, Chuncheon, 8Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
Received: January 26, 2018; Accepted: March 5, 2018; Published online: March 5, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: 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.
Methods: 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, that 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.
Results: 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.

Conclusion: 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.
Keywords: Efficacy, Long-acting injectable, Safety, Schizophrenia, Second-generation antipsychotics


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