Comparative Efficacy of First and Second Generation long-acting injectable antipsychotic upon schizophrenic patients: a systematic review and network meta-analysis

Abstract

Introduction: Long-acting injectable antipsychotics (LAIA) can lead the course of treatment with the potential to increase adherence in schizophrenia treatment. The objective of this systematic review and network meta-analysis is to find the efficacy of SG-LAIAs, FG-LAIAs compared to each other for schizophrenia. Methods: This systematic review and network meta-analysis was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), with registration in Prospero (ID CRD42019128700). A database in MEDLINE, EMBASE, Web of Science, and Scopus, until June 17, 2020, with an actualization from June 2020 to September 14, 2021.  Results: The SMDs for the four (80%) antipsychotics that significantly reduced PANSS score compared with placebo ranged between –0·72 (95% CrI –0·99 to –0·46) for haloperidol to –0·45 (–0·54 to –0·37) for paliperidone. 8 studies reported usable results for negative symptoms and positive symptoms (Four antipsychotics compared). The SMDs for the three (75%) antipsychotics that significantly reduced negative symptoms compared with placebo ranged between –0·40 (95% CrI –0·53 to –0·26) for aripiprazole to –0·32 (–0·44 to –0·19) for risperidone. The SMDs for the three (100%) drugs that significantly reduced positive symptoms compared with placebo ranged between –0·50 (95% CrI –0·63 to –0·37) for aripiprazole to –0·19 (–0·57 to 0·20) for zuclopenthixol. Discussion: We found evidence suggesting that all long-acting injectable antipsychotics, except for zuclopenthixol, are equally efficient in reducing symptoms in schizophrenia, Conclusions: Most LAIAs are equally efficient at reducing overall symptoms, and differences between individual LAIAs are non-significant.