Second Generation Antipsychotic Long Acting Injections in Bipolar Disorder: Systematic review & meta-analysis

Asta R. Prajapati, Jonathan Wilson, Fujian Song, Ian Maidment

Research output: Contribution to journalArticle

Abstract

Background: Non-adherence is a significant problem in bipolar disorder. Second-generation antipsychotics (SGA) long-acting injections (LAIs) may improve adherence in bipolar disorder and may prevent relapses. However, the evidence is limited and conflicting. Objective: The objective of this study was to evaluate efficacy and safety of SGA LAIs in bipolar disorder. Method: Systematic review and meta-analysis of randomised controlled trials (RCTs) (≥6 months duration) investigating safety and efficacy of SGA LAIs for bipolar disorder. We searched Pubmed, Embase, CINAHL, Cochrane, PsycINFO, LiLACS, www.clinicaltrials.gov up to October 2016. We also contacted the manufacturers of SGA LAIs. Primary efficacy and safety outcomes were relapse rate and all-cause discontinuation respectively. Results: Total of seven RCTs (n = 1192) were included. SGA LAIs show superiority over placebo for study-defined relapse rate (RR = 0.58, 95% CI = 0.49-0.68, P < 0.00001) and all-cause discontinuation (RR = 0.72, 95% CI = 0.64-0.82, P < 0.00001). However, no significant difference was found between SGA LAIs and oral active control for relapse rate (RR = 0.92, P = 0.79) and all-cause discontinuation (RR = 1.2, P = 0.31). In terms of secondary outcomes, SGA LAIs performed better than placebo in relapse to mania/hypomania, young mania rating scales (YMRS), clinical global impression-severity (CGI-S), montgomery-asberg depression rating scale (MADRS). There was no significant difference between SGA LAIs and oral active control regarding relapse to mania/hypomania, YMRS, CGI-S, extra-pyramidal side effects (EPSEs), weight gain. However, the active control performed better than SGA LAIs in relapse to depression, MADRS, and prolactin-related AEs. Conclusions: Current evidence is very limited to support the use of SGA LAIs (compared to oral medication) in bipolar disorder. Further high-quality studies, particularly comparing SGA LAIs with active control, are warranted.
Original languageEnglish
Pages (from-to)687-696
JournalBipolar Disorders
Volume20
Issue number8
Early online date11 Nov 2018
DOIs
Publication statusPublished - 1 Dec 2018

Fingerprint

Bipolar Disorder
Antipsychotic Agents
Meta-Analysis
Injections
Recurrence
Depression
Safety
Randomized Controlled Trials
Placebos
PubMed
Prolactin
Weight Gain

Bibliographical note

© 2018 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Keywords

  • Mental Health
  • Bipolar Disorder
  • Second Generation Antipsychotic
  • Antipsychotic Long Acting Injection
  • Antipsychotic Depots
  • Meta-analysis

Cite this

Prajapati, Asta R. ; Wilson, Jonathan ; Song, Fujian ; Maidment, Ian. / Second Generation Antipsychotic Long Acting Injections in Bipolar Disorder : Systematic review & meta-analysis. In: Bipolar Disorders. 2018 ; Vol. 20, No. 8. pp. 687-696.
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Second Generation Antipsychotic Long Acting Injections in Bipolar Disorder : Systematic review & meta-analysis. / Prajapati, Asta R.; Wilson, Jonathan; Song, Fujian; Maidment, Ian.

In: Bipolar Disorders, Vol. 20, No. 8, 01.12.2018, p. 687-696.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Second Generation Antipsychotic Long Acting Injections in Bipolar Disorder

T2 - Systematic review & meta-analysis

AU - Prajapati, Asta R.

AU - Wilson, Jonathan

AU - Song, Fujian

AU - Maidment, Ian

N1 - © 2018 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Non-adherence is a significant problem in bipolar disorder. Second-generation antipsychotics (SGA) long-acting injections (LAIs) may improve adherence in bipolar disorder and may prevent relapses. However, the evidence is limited and conflicting. Objective: The objective of this study was to evaluate efficacy and safety of SGA LAIs in bipolar disorder. Method: Systematic review and meta-analysis of randomised controlled trials (RCTs) (≥6 months duration) investigating safety and efficacy of SGA LAIs for bipolar disorder. We searched Pubmed, Embase, CINAHL, Cochrane, PsycINFO, LiLACS, www.clinicaltrials.gov up to October 2016. We also contacted the manufacturers of SGA LAIs. Primary efficacy and safety outcomes were relapse rate and all-cause discontinuation respectively. Results: Total of seven RCTs (n = 1192) were included. SGA LAIs show superiority over placebo for study-defined relapse rate (RR = 0.58, 95% CI = 0.49-0.68, P < 0.00001) and all-cause discontinuation (RR = 0.72, 95% CI = 0.64-0.82, P < 0.00001). However, no significant difference was found between SGA LAIs and oral active control for relapse rate (RR = 0.92, P = 0.79) and all-cause discontinuation (RR = 1.2, P = 0.31). In terms of secondary outcomes, SGA LAIs performed better than placebo in relapse to mania/hypomania, young mania rating scales (YMRS), clinical global impression-severity (CGI-S), montgomery-asberg depression rating scale (MADRS). There was no significant difference between SGA LAIs and oral active control regarding relapse to mania/hypomania, YMRS, CGI-S, extra-pyramidal side effects (EPSEs), weight gain. However, the active control performed better than SGA LAIs in relapse to depression, MADRS, and prolactin-related AEs. Conclusions: Current evidence is very limited to support the use of SGA LAIs (compared to oral medication) in bipolar disorder. Further high-quality studies, particularly comparing SGA LAIs with active control, are warranted.

AB - Background: Non-adherence is a significant problem in bipolar disorder. Second-generation antipsychotics (SGA) long-acting injections (LAIs) may improve adherence in bipolar disorder and may prevent relapses. However, the evidence is limited and conflicting. Objective: The objective of this study was to evaluate efficacy and safety of SGA LAIs in bipolar disorder. Method: Systematic review and meta-analysis of randomised controlled trials (RCTs) (≥6 months duration) investigating safety and efficacy of SGA LAIs for bipolar disorder. We searched Pubmed, Embase, CINAHL, Cochrane, PsycINFO, LiLACS, www.clinicaltrials.gov up to October 2016. We also contacted the manufacturers of SGA LAIs. Primary efficacy and safety outcomes were relapse rate and all-cause discontinuation respectively. Results: Total of seven RCTs (n = 1192) were included. SGA LAIs show superiority over placebo for study-defined relapse rate (RR = 0.58, 95% CI = 0.49-0.68, P < 0.00001) and all-cause discontinuation (RR = 0.72, 95% CI = 0.64-0.82, P < 0.00001). However, no significant difference was found between SGA LAIs and oral active control for relapse rate (RR = 0.92, P = 0.79) and all-cause discontinuation (RR = 1.2, P = 0.31). In terms of secondary outcomes, SGA LAIs performed better than placebo in relapse to mania/hypomania, young mania rating scales (YMRS), clinical global impression-severity (CGI-S), montgomery-asberg depression rating scale (MADRS). There was no significant difference between SGA LAIs and oral active control regarding relapse to mania/hypomania, YMRS, CGI-S, extra-pyramidal side effects (EPSEs), weight gain. However, the active control performed better than SGA LAIs in relapse to depression, MADRS, and prolactin-related AEs. Conclusions: Current evidence is very limited to support the use of SGA LAIs (compared to oral medication) in bipolar disorder. Further high-quality studies, particularly comparing SGA LAIs with active control, are warranted.

KW - Mental Health

KW - Bipolar Disorder

KW - Second Generation Antipsychotic

KW - Antipsychotic Long Acting Injection

KW - Antipsychotic Depots

KW - Meta-analysis

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DO - 10.1111/bdi.12707

M3 - Article

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JO - Bipolar Disorders

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