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Zhao YJ, Lin L, Teng M, et al. Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials. BJPsych Open. 2016;2(1):59-66doi: 10.1192/bjpo.bp.115.002576.
Zhao, Y. J., Lin, L., Teng, M., Khoo, A. L., Soh, L. B., Furukawa, T. A., Baldessarini, R. J., Lim, B. P., & Sim, K. (2016). Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials. BJPsych open, 2(1), 59-66. https://doi.org/10.1192/bjpo.bp.115.002576
Zhao, Ying Jiao, et al. "Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials." BJPsych open vol. 2,1 (2016): 59-66. doi: https://doi.org/10.1192/bjpo.bp.115.002576
Zhao YJ, Lin L, Teng M, Khoo AL, Soh LB, Furukawa TA, Baldessarini RJ, Lim BP, Sim K. Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials. BJPsych Open. 2016 Feb 05;2(1):59-66. doi: 10.1192/bjpo.bp.115.002576. eCollection 2016 Jan. PMID: 27703755; PMCID: PMC4995551.
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BJPsych Open. 2016 Feb 05;2(1):59-66. doi: 10.1192/bjpo.bp.115.002576. eCollection 2016 Jan.

Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials.

BJPsych open

Ying Jiao Zhao, Liang Lin, Monica Teng, Ai Leng Khoo, Lay Beng Soh, Toshiaki A Furukawa, Ross J Baldessarini, Boon Peng Lim, Kang Sim

Affiliations

  1. , PhD.
  2. , MSc (IHTA).
  3. , MHSc.
  4. , PhD, Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore, Singapore.
  5. , BPharm, Department of Pharmacy, Institute of Mental Health, Singapore, Singapore.
  6. , MD, Department of Health Promotion and Human Behavior, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Clinical Epidemiology, Graduate School of Public Health, Kyoto University, Kyoto, Japan.
  7. , MD, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA, International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.
  8. , BPharm, Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore, Singapore.
  9. , MBBS, MMed (Psychiatry), FAMS, Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

PMID: 27703755 PMCID: PMC4995551 DOI: 10.1192/bjpo.bp.115.002576

Abstract

BACKGROUND: For treatment of patients diagnosed with schizophrenia, comparative long-term effectiveness of antipsychotic drugs to reduce relapses when minimising adverse effects is of clinical interest, hence prompting this review.

AIMS: To evaluate the comparative long-term effectiveness of antipsychotic drugs.

METHOD: We systematically searched electronic databases for reports of randomised controlled trials (RCTs) of antipsychotic monotherapy aimed at reducing relapse risks in schizophrenia. We conducted network meta-analysis of 18 antipsychotics and placebo.

RESULTS: Studies of 10 177 patients in 56 reports were included; treatment duration averaged 48 weeks (range 4-156). Olanzapine was significantly more effective than chlorpromazine (odds ratio (OR) 0.35, 95% CI 0.14-0.88) or haloperidol (OR=0.50, 95% CI 0.30-0.82); and fluphenazine decanoate was more effective than chlorpromazine (OR=0.31, 95% CI 0.11-0.88) in relapse reduction. Fluphenazine decanoate, haloperidol, haloperidol decanoate and trifluoperazine produced more extrapyramidal adverse effects than olanzapine or quetiapine; and olanzapine was associated with more weight gain than other agents.

CONCLUSIONS: Except for apparent superiority of olanzapine and fluphenazine decanoate over chlorpromazine, most agents showed intermediate efficacy for relapse prevention and differences among them were minor. Typical antipsychotics yielded adverse neurological effects, and olanzapine was associated with weight gain. The findings may contribute to evidence-based treatment selection for patients with chronic psychotic disorders.

DECLARATION OF INTEREST: R.J.B. received grants from the Bruce J. Anderson Foundation and the McLean Private Donors Psychopharmacology Research Fund.

COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

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