Efficacy of long‐acting injectable versus oral antipsychotic drugs in early psychosis: A systematic review and meta‐analysis

• Published in: Early intervention in psychiatry Vol. 16; no. 6; pp. 589 - 599
• Main Authors: Lian, Lulu, Kim, David D., Procyshyn, Ric M., Fredrikson, Diane H., Cázares, Diana, Honer, William G., Barr, Alasdair M.
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.06.2022; Wiley Subscription Services, Inc
• Subjects: Administration, Oral; antipsychotic; Antipsychotic Agents - therapeutic use; Antipsychotics; Delayed-Action Preparations - therapeutic use; Drugs; Effectiveness; Hospitalization; Humans; long‐acting injectable; Meta-analysis; oral antipsychotic; Psychosis; Psychotic Disorders - drug therapy; Psychotropic drugs; Recurrence; Schizophrenia; meta-analysis; oral antipsychotic; long-acting injectable; antipsychotic; schizophrenia; psychosis
• ISSN: 1751-7885; 1751-7893; 1751-7893
• DOI: 10.1111/eip.13202

Aim Long‐acting injectable antipsychotic drugs (LAIs) are often used as an alternative to oral antipsychotics (OAPs) in individuals with psychosis who demonstrate poor medication adherence. Previous meta‐analyses have found mixed results on the efficacy of LAIs, compared to OAPs, in patients with psychotic disorders. The objective of this meta‐analysis was to compare the effectiveness of using LAIs versus OAPs in the early stages of psychosis. Methods Major electronic databases were used to search for any studies examining the comparative effectiveness (i.e., relapse, adherence, hospitalization, and all‐cause discontinuation) of any LAIs versus OAPs in early stages of psychosis. Studies published up to 6 June, 2019 were included and no language restriction was applied. Inclusion criteria were a diagnosis of schizophrenia or related disorder, where patients were in their first episode or had a duration of illness ≤5 years. Data were analysed using a random‐effects model. Results Fifteen studies (n = 10 584) were included, of which were 7 RCTs, 7 observational studies, and 1 post‐hoc analysis. We found that LAIs provided advantages over OAPs in terms of relapse rates. No significant differences were found between LAI and OAP groups in terms of all‐cause discontinuation, hospitalization, and adherence rates. However, considering only RCTs revealed advantages of LAIs over OAPs in terms of hospitalization rates. Conclusions LAIs may provide benefits over OAPs with respect to reducing relapse and hospitalization rates in early psychosis patients. There is a need for larger and better‐designed studies comparing OAPs and LAIs specifically in early psychosis patients.