No clear difference among antipsychotic agents in preventing relapse in adults with schizophrenia

Reference

Schneider-Thoma J, Chalkou K, Dorries C, et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet 2022;399(10327):824-836.

Synopsis

This team searched PubMed and the Cochrane Schizophrenia Group’s specialized registry of studies and identified 127 randomized trials (with 18,152 adult participants) that evaluated 32 different antipsychotic agents used to prevent relapse in adults with schizophrenia. The authors contacted the corresponding authors and manufacturers to obtain missing data and data from unpublished studies. The authors don’t report on the quality of the included studies. Of the 127 trials, 100 (16,812 participants and 30 antipsychotics) provided enough data for the authors to perform a Bayesian network meta-analysis. Compared with placebo, each of the antipsychotic agents prevented relapse (relative risks < 1.0) and none of the credible intervals included 1, except for cariprazine oral, lurasidone oral, and clopenthixol long-acting injectable. Additionally, the credible intervals overlapped enough that the authors were unable to say that any agent was significantly superior to any other in relapse prevention. Although the data were relatively sparse, the authors also found no conclusive advantage of any of the agents in improving overall symptoms, preventing rehospitalization, remission, recovery, quality of life, and overall functioning. Compared with placebo, fluphenazine long-acting injectable, haloperidol oral, haloperidol long-acting injectable, and aripiprazole long-acting injectable were associated with an increased use of antiparkinson medication. Overall, the rate of tardive dyskinesia (< 1%) was too low to draw any conclusions.