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

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

doi:10.1111/bdi.12707

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 journal › Article › peer-review

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 language	English
Pages (from-to)	687-696
Journal	Bipolar Disorders
Volume	20
Issue number	8
Early online date	11 Nov 2018
DOIs	https://doi.org/10.1111/bdi.12707
Publication status	Published - 1 Dec 2018

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

Access to Document

10.1111/bdi.12707Licence: CC BY-NC-ND 3.0

Second‐generation antipsychotic long‐acting injections in bipolar disorder
© 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.
Final published version, 828 KBLicence: CC BY-NC-ND 3.0

Cite this

@article{1fbe45a3f6be4943b6777b83acf2e166,

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

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.",

keywords = "Mental Health, Bipolar Disorder, Second Generation Antipsychotic, Antipsychotic Long Acting Injection, Antipsychotic Depots, Meta-analysis",

author = "Prajapati, {Asta R.} and Jonathan Wilson and Fujian Song and Ian Maidment",

note = "{\textcopyright} 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.",

year = "2018",

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day = "1",

doi = "10.1111/bdi.12707",

language = "English",

volume = "20",

pages = "687--696",

journal = "Bipolar Disorders",

issn = "1398-5647",

publisher = "Blackwell",

number = "8",

}

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

UR - https://onlinelibrary.wiley.com/doi/full/10.1111/bdi.12707

U2 - 10.1111/bdi.12707

DO - 10.1111/bdi.12707

M3 - Article

SN - 1398-5647

VL - 20

SP - 687

EP - 696

JO - Bipolar Disorders

JF - Bipolar Disorders

IS - 8

ER -