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. 2016 Feb 5;2(1):59-66.
doi: 10.1192/bjpo.bp.115.002576. eCollection 2016 Jan.

Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials

Affiliations

Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials

Ying Jiao Zhao et al. BJPsych Open. .

Abstract

Background: For treatment of patients diagnosed with schizophrenia, comparative long-term effectiveness of antipsychotic drugs to reduce relapses when minimising adverse effects is of clinical interest, hence prompting this review.

Aims: To evaluate the comparative long-term effectiveness of antipsychotic drugs.

Method: We systematically searched electronic databases for reports of randomised controlled trials (RCTs) of antipsychotic monotherapy aimed at reducing relapse risks in schizophrenia. We conducted network meta-analysis of 18 antipsychotics and placebo.

Results: Studies of 10 177 patients in 56 reports were included; treatment duration averaged 48 weeks (range 4-156). Olanzapine was significantly more effective than chlorpromazine (odds ratio (OR) 0.35, 95% CI 0.14-0.88) or haloperidol (OR=0.50, 95% CI 0.30-0.82); and fluphenazine decanoate was more effective than chlorpromazine (OR=0.31, 95% CI 0.11-0.88) in relapse reduction. Fluphenazine decanoate, haloperidol, haloperidol decanoate and trifluoperazine produced more extrapyramidal adverse effects than olanzapine or quetiapine; and olanzapine was associated with more weight gain than other agents.

Conclusions: Except for apparent superiority of olanzapine and fluphenazine decanoate over chlorpromazine, most agents showed intermediate efficacy for relapse prevention and differences among them were minor. Typical antipsychotics yielded adverse neurological effects, and olanzapine was associated with weight gain. The findings may contribute to evidence-based treatment selection for patients with chronic psychotic disorders.

Declaration of interest: R.J.B. received grants from the Bruce J. Anderson Foundation and the McLean Private Donors Psychopharmacology Research Fund.

Copyright and usage: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

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Figures

Fig. 1
Fig. 1. Flowchart of selection of reports for inclusion in study-based PRISMA recommendations (www.prisma-statement.org/statement.htm) to yield 56 study reports included in analyses
Fig. 2
Fig. 2. Network of all direct and indirect comparisons between antipsychotics. LAI, long-acting injection
Fig. 3
Fig. 3. Forest plot for relapse rate of antipsychotics compared with placebo. LAI, long-acting injection; OR, odds ratio
Fig. 4
Fig. 4. Relapse rate and discontinuation because of all reasons for all antipsychotics
AMI, amisulpride; ARI, aripiprazole; CHL, chlorpromazine; FLX, flupenthixol decanoate; FLZ, fluphenazine decanoate; HAL, haloperidol; LAI, long-acting injection; OLA, olanzapine; PAL, paliperidone; PBO, placebo; PIP, pipothiazine palmitate; QUE, quetiapine; RIS, risperidone; SUL, sulpiride; TRI, trifluoperazine; ZIP, ziprasidone; ZUC, zuclopenthixol decanoate.
Fig. 5
Fig. 5. Extrapyramidal symptoms in the context of antipsychotic use
AMI, amisulpride; ARI, aripiprazole; CHL, chlorpromazine; FLX, flupenthixol decanoate; FLZ, fluphenazine decanoate; HAL, haloperidol; LAI, long-acting injection; OLA, olanzapine; PAL, paliperidone; PBO, placebo; PIP, pipothiazine palmitate; QUE, quetiapine; RIS, risperidone; SUL, sulpiride; TRI, trifluoperazine; ZIP, ziprasidone; ZUC, zuclopenthixol decanoate.

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