Maintenance Treatment With Long-Acting Injectable Antipsychotics for People With Nonaffective Psychoses: A Network Meta-Analysis

• DOI: 10.1176/appi.ajp.2020.20071120
• Publication Date: 2021-02-18T08:01:47Z
• Authors: Giovanni Ostuzzi; Federico Bertolini; Cinzia Del Giovane; Federico Tedeschi; Chiara Bovo; Chiara Gastaldon; Michela Nosé; Filippo Ogheri; Davide Papola; Marianna Purgato; Giulia Turrini; Christoph U. Correll; Corrado Barbui
• Keywords: Network Meta-Analysis; Aripiprazole; Injections, Intramuscular; depot formulation; 03 medical and health sciences; 0302 clinical medicine; Phenothiazines; Paliperidone Palmitate; Fluphenazine; Secondary Prevention; Humans; relapse prevention; network mMeta-analysis; maintenance treatment; Clopenthixol; Patient Acceptance of Health Care; Risperidone; 3. Good health; Flupenthixol; antipsychotics; Psychotic Disorders; Olanzapine; Delayed-Action Preparations; Schizophrenia; Haloperidol; Antipsychotic Agents

Objective: This study compared relapse prevention and acceptability of long-acting injectable (LAI) antipsychotics in the maintenance treatment adults with nonaffective psychoses. Methods: The authors searched MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, online registers for randomized controlled trials published until June 2020. Relative risks standardized mean differences were pooled using random-effects pairwise network meta-analysis. primary outcomes rate all-cause discontinuation ("acceptability"). quality included studies was rated Cochrane Risk Bias tool, certainty estimates measured GRADE (Grading Recommendations Assessment, Development, Evaluation). Results: Of 86 eligible trials, 78 (N=11,505) Regarding prevention, most 12 LAIs outperformed placebo. largest point best rankings placebo found paliperidone (3-month formulation) aripiprazole. Moderate to high superior also (in descending ranking order) risperidone, pipothiazine, olanzapine, (1-month formulation). In head-to-head comparisons LAIs, only haloperidol inferior aripiprazole, fluphenazine, paliperidone. For acceptability, placebo, moderate zuclopenthixol, formulation), flupenthixol, comparisons, LAI aripiprazole had other (bromperidol, [1-month formulation], risperidone). Conclusions: formulations showed highest effect sizes evidence both acceptability. Results from this meta-analysis should inform frontline clinicians guidelines.