Clin Psychopharmacol Neurosci 2018; 16(4): 361-375  
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 Park1,*, Mi Young Choi2,*, Jina Choi2, Eunjung Park2, Ha Jin Tchoe2, Jae Kyung Suh2, Young Hoon Kim3, Seung Hee Won4, Young-Chul Chung5, Kyung-Yeol Bae6, Sang-Kyu Lee7, Chan Mi Park2, Seung-Hwan Lee8
1Department of Psychiatry, Haeundae Paik Hospital, Inje University College of Medicine Busan, 2National Evidence-based Healthcare Collaborating Agency, Seoul, 3Department of Psychiatry, Gongju National Hospital, Gongju, 4Department of Psychiatry, School of Medicine, Kyungpook National University, 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, Hallym University College of Medicine, Chuncheon, 8Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
Correspondence to: Seung-Hwan Lee, MD, PhD
Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea
Tel: +82-31-910-7260, Fax: +82-31-910-7268
E-mail: lshpss@hanmail.net
ORCID: https://orcid.org/0000-0003-0305-3709
Chan Mi Park, PhD
National Evidence-based Healthcare Collaborating Agency, Namasan Square (Kukdong B/D) 7F, 173 Toegye-ro, Jung-gu, Seoul 04554, Korea
Tel: +82-2-2174-2720, Fax: +82-2-747-4916
E-mail: chpark@neca.re.kr
*These authors contributed equally to this study as co-first authors.
Received: February 1, 2018; Accepted: March 5, 2018; Published online: November 30, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Efficacy; Long-acting injectable; Safety; Schizophrenia; Second-generation antipsychotics.


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