First-generation antipsychotic long-acting injections v. oral antipsychotics in schizophrenia: Systematic review of randomised controlled trials and observational studies
- 1 November 2009
- journal article
- review article
- Published by Royal College of Psychiatrists in The British Journal of Psychiatry
- Vol. 195 (S52), s20-s28
- https://doi.org/10.1192/bjp.195.52.s20
Abstract
Background Antipsychotic long-acting injections (LAIs) are often used in an attempt to improve medication adherence in people with schizophrenia. Aims To compare first-generation antipsychotic long-acting injections (FGA–LAIs) with first- and second-generation oral antipsychotics in terms of clinical outcome. Method Systematic literature review. Results A meta-analysis of randomised controlled trials (RCTs) showed no difference in relapse or tolerability between oral antipsychotics and FGA–LAIs but global improvement was twice as likely with FGA–LAIs. Four prospective observational studies were identified; two studies reported lower discontinuation rates for FGA–LAIs compared with oral medication and two found that outcome was either no different or better with oral antipsychotics. Mirror-image studies consistently showed reduced in-patient days and admissions following a switch from oral antipsychotics to FGA–LAIs. Conclusions The results are variable and inconclusive. Some evidence suggests that FGA–LAIs may improve outcome compared with oral antipsychotics. Methodological issues may partly explain the variable results. Selective recruitment in RCTs and lack of randomisation in observational studies are biases against LAIs, whereas regression to the mean in mirror-image studies favours LAIs. In terms of future research, a long-term pragmatic RCT of an FGA–LAI against an oral antipsychotic, in patients with problematic adherence, would be of value.Keywords
This publication has 48 references indexed in Scilit:
- A new self-rating scale for detecting atypical or second-generation antipsychotic side effectsJournal of Psychopharmacology, 2008
- Bed numbers as a limitation to acute in-patient carePsychiatric Bulletin, 2007
- What works in schizophrenia: Depot preparations may improve outcomesBMJ, 2006
- Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up studyBMJ, 2006
- Depot pipotiazine palmitate and undecylenate for schizophreniaCochrane Database of Systematic Reviews, 2004
- The Texas Medication Algorithm Project Antipsychotic Algorithm for SchizophreniaThe Journal of Clinical Psychiatry, 2004
- Long Term Depot AntipsychoticsDrug Safety, 1994
- Depot Antipsychotic DrugsDrugs, 1994
- A follow-up study of schizophrenic outpatients treated with depot-neurolepticsProgress in Neuro-Psychopharmacology, 1981
- THE CONTRIBUTION OF FLUPHENAZINE ENANTHATE AND DECANOATE IN THE PREVENTION OF READMISSION OF SCHIZOPHRENIC PATIENTSActa Psychiatrica Scandinavica, 1971