Oral versus depot antipsychotic drugs for schizophrenia—A critical systematic review and meta-analysis of randomised long-term trials

@article{Leucht2011OralVD,
  title={Oral versus depot antipsychotic drugs for schizophrenia—A critical systematic review and meta-analysis of randomised long-term trials},
  author={Claudia Leucht and Stephan Heres and John M. Kane and Werner Kissling and Stefan Leucht},
  journal={Schizophrenia Research},
  year={2011},
  volume={127},
  pages={83-92}
}
The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis.
TLDR
The overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia, and support clinical practice in encouraging providers to prescribe LAIs when indicated.
Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome
TLDR
Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small.
Efficacy of long-acting injectable versus oral antipsychotic drugs in early psychosis: A systematic review and meta-analysis.
TLDR
LAIs may provide benefits over OAPs with respect to reducing relapse and hospitalization rates in early psychosis patients, and there is a need for larger and better-designed studies comparing O APs and LAIs specifically inEarly psychosis patients.
Long-Acting Injectable Antipsychotics in Schizophrenia: Literature Review and Practical Perspective, with a Focus on Aripiprazole Once-Monthly
TLDR
Results across the “full spectrum” of efficacy in traditional clinical trials as well as those encompassing the concept of effectiveness in a more naturalistic setting of real-life clinical practice support the use of AOM 400 as a valid long-term treatment option in schizophrenia overall, aswell as earlier in the treatment course, and not solely in situations of poor adherence or when oral antipsychotics have failed.
Efficacy, tolerability, and safety of aripiprazole once-monthly versus other long-acting injectable antipsychotic therapies in the maintenance treatment of schizophrenia: a mixed treatment comparison of double-blind randomized clinical trials
TLDR
Aripiprazole once-monthly is similarly efficacious to other LAI antipsychotic medication with relatively low rates of discontinuation due to AEs and due to reasons other than AEs than other LAIs.
Effect of prior treatment with antipsychotic long-acting injection on randomised clinical trial treatment outcomes.
TLDR
A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antippsychotic to another, and this effect appears to be moderated by adherence, and may not extend to switching to clozapine.
Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
TLDR
The relevance of the somewhat greater efficacy of SGAs over FGAs on several key outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol.
Review: depot antipsychotics may reduce risk of relapse compared with oral antipsychotics in people with schizophrenia
  • C. Arango
  • Psychology, Medicine
    Evidence Based Mental Health
  • 2011
TLDR
It seems unexpected that, despite the lower relapse rate, the main reason for the clinical use of depot medication does not seem to improve in depot-treated patients, and a large RCT with stable outpatients who are assigned to either an oral or depot form of the same antipsychotic with blinded raters is needed in future studies.
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References

SHOWING 1-10 OF 49 REFERENCES
Systematic meta-review of depot antipsychotic drugs for people with schizophrenia
Background Long-acting depot antipsychotic medication is a widely used treatment for schizophrenia. Aims To synthesise relevant systematic Cochrane reviews. Method The Cochrane Database was searched
Depot risperidone for schizophrenia.
TLDR
There is no reliable data to support the claim that depot risperidone is beneficial for people with schizophrenia, and for reasonably well, stable people it may mean that the need for regular oral doses can be avoided, but adverse affects are not well reported.
Relapse Prevention in Schizophrenia and Schizoaffective Disorder with Risperidone Long-Acting Injectable vs Quetiapine: Results of a Long-Term, Open-Label, Randomized Clinical Trial
TLDR
Time-to-relapse in stable patients with schizophrenia or schizoaffective disorder was significantly longer in patients randomized to RLAI compared with those randomized to oral quetiapine, and both antipsychotics were generally well tolerated.
Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials
TLDR
Among adults with moderate to severe major depression in the clinical trials the authors reviewed, paroxetine was not superior to placebo in terms of overall treatment effectiveness and acceptability.
Depot fluspirilene for schizophrenia.
TLDR
There are no convincing data showing fluspirilene decanoate's advantage over oral chlorpromazine or other depot antipsychotic preparations for people with schizophrenia in terms of clinical, social and economic outcomes and well-conducted and reported randomised trials are still needed to inform practice.
A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia.
TLDR
The findings suggest that some second-generation antipsychotics may be somewhat more efficacious than others, but the limitations of meta-analysis must be considered in tailoring drug treatment to the individual patient.
Depot haloperidol decanoate for schizophrenia.
TLDR
Haloperidol decanoate may have a substantial effect in improving the symptoms and behaviour associated with schizophrenia in comparison to placebo, but data are remarkably sparse.
Depot pipotiazine palmitate and undecylenate for schizophrenia.
TLDR
P pipotiazine palmitate was consistently equivalent to other depots in terms of a range of outcomes, including global impression and behaviour, and there was no reported difference in adverse effects such as tardive dyskinesia or the need for anticholinergic drugs.
Depot flupenthixol decanoate for schizophrenia or other similar psychotic disorders.
TLDR
There is nothing to choose between flupenthixol decanoate and other depot antipsychotic drugs, and the choice of which depot to use must therefore be based on clinical judgement and the preferences of people with schizophrenia and their carers.
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