Clinical Psychopharmacology and Neuroscience

Korean College of Neuropsychopharmacology (대한정신약물학회)
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Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis

  • Park, Seon-Cheol (Department of Psychiatry, Haeundae Paik Hospital, Inje University College of Medicine Busan) ;
  • Choi, Mi Young (National Evidence-based Healthcare Collaborating Agency) ;
  • Choi, Jina (National Evidence-based Healthcare Collaborating Agency) ;
  • Park, Eunjung (National Evidence-based Healthcare Collaborating Agency) ;
  • Tchoe, Ha Jin (National Evidence-based Healthcare Collaborating Agency) ;
  • Suh, Jae Kyung (National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Young Hoon (Department of Psychiatry, Gongju National Hospital) ;
  • Won, Seung Hee (Department of Psychiatry, School of Medicine, Kyungpook National University) ;
  • Chung, Young-Chul (Department of Psychiatry, Chonbuk National University Hospital) ;
  • Bae, Kyung-Yeol (Department of Psychiatry, Chonnam National University Medical School) ;
  • Lee, Sang-Kyu (Department of Psychiatry, Hallym University Chuncheon Sacred Hospital, Hallym University College of Medicine) ;
  • Park, Chan Mi (National Evidence-based Healthcare Collaborating Agency) ;
  • Lee, Seung-Hwan (Department of Psychiatry, Inje University Ilsan Paik Hospital)
  • Received : 2018.02.01
  • Accepted : 2018.03.05
  • Published : 2018.11.30
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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 $D_2$ antagonism-related symptoms.

Keywords

Acknowledgement

Supported by : National Evidence-based Healthcare Collaborating Agency

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