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首页> 外文期刊>The journal of clinical psychiatry >Long-acting injectable versus oral antipsychotics in schizophrenia: A systematic review and meta-analysis of mirror-image studies
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Long-acting injectable versus oral antipsychotics in schizophrenia: A systematic review and meta-analysis of mirror-image studies

机译：精神分裂症中长效注射抗精神病药与口服抗精神病药的比较：镜像研究的系统评价和荟萃分析

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Objective: Recent, large, randomized controlled trials (RCTs) showed no benefit of long-acting injectable (LAI) antipsychotics over oral antipsychotics in preventing relapse in schizophrenia, nor did a recent meta-analysis incorporating these studies. However, RCTs might enroll a disproportionate number of patients with better treatment adherence and lower illness severity. Mirrorimage studies, which compare periods of oral antipsychotic versus LAI treatment in the same patients, might therefore better reflect the real-world impact of LAIs. Data Sources: A systematic literature search without language restriction was conducted using MEDLINE/PubMed, Cochrane Library, Web of Science, PsycINFO, and CINAHL until May 31, 2012. Search terms included synonyms of (1) antipsychotic(s) AND (2) schizophrenia and related disorders AND (3) depot, (long-acting) injection(s), microsphere, decanoate, palmitate, enanthate. Study Selection: Of 5,483 identified citations, 607 articles were fully inspected, and 582 were ineligible. Finally, 25 mirror-image studies from 28 countries that followed 5,940 patients with schizophrenia for ≥ 12 months (≥ 6 months each on oral antipsychotic and LAI treatment) met the inclusion criteria and were analyzed. Data Extraction: Coprimary outcomes were hospitalization risk and number of hospitalizations. Secondary outcomes included hospitalization days and length of stay. Data Synthesis: LAIs showed strong superiority over oral antipsychotics in preventing hospitalization (16 studies, N = 4,066; risk ratio = 0.43; 95% CI, 0.35-0.53; P < .001) and in decreasing the number of hospitalizations (15 studies, 6,342 person-years; rate ratio = 0.38; 95% CI, 0.28-0.51; P < .001). This strong advantage was also observed for secondary outcomes and in multiple clinically relevant subpopulations and treatment groups. Conclusions: Results from mirror-image studies in patients eligible for clinical use of LAIs showed strong superiority of LAIs compared to oral antipsychotics in preventing hospitalization. The results were in contrast to the recent meta-analysis of RCTs, which showed no superiority of LAIs. Given the possible biases in mirrorimage studies, such as expectation bias, natural illness course, and time effect, a cautious interpretation is required. Nevertheless, the population in mirror-image studies better reflects the population receiving LAIs in clinical practice.
机译：目的：最近的大型随机对照试验（RCT）显示，长效注射（LAI）抗精神病药在预防精神分裂症复发方面没有优于口服抗精神病药的益处，最近的荟萃分析也没有纳入这些研究。但是，RCT可能会招募更多比例的患者，这些患者具有更好的治疗依从性和更低的疾病严重性。镜像研究比较了同一患者的口服抗精神病药和LAI的治疗时间，因此可能会更好地反映LAI在现实世界中的影响。数据来源：截至2012年5月31日，使用MEDLINE / PubMed，Cochrane图书馆，Web of Science，PsycINFO和CINAHL进行了系统的无语言限制的文献检索。检索词包括（1）抗精神病药和（2）的同义词精神分裂症和相关疾病，以及（3）贮库，（长效）注射剂，微球，癸酸酯，棕榈酸酯，庚酸酯。研究选择：在5,483篇被引用的文献中，有607篇文章经过了全面检查，其中582篇不合格。最后，来自28个国家的25项镜像研究随访了5940例精神分裂症患者≥12个月（口服抗精神病药和LAI治疗均≥6个月），符合纳入标准并进行了分析。数据提取：共同的主要结果是住院风险和住院次数。次要结果包括住院天数和住院时间。数据综合：LAI在预防住院方面显示出优于口服抗精神病药的优势（16个研究，N = 4,066;风险比= 0.43; 95％CI，0.35-0.53; P <.001）和减少住院次数（15个研究， 6,342人年;比率= 0.38; 95％CI，0.28-0.51; P <.001）。在次要结果以及多个临床相关亚人群和治疗组中也观察到了这一强大优势。结论：对符合临床使用LAIs条件的患者进行镜像研究的结果显示，与口服抗精神病药相比，LAIs在预防住院方面具有更强的优势。结果与最近的RCT荟萃分析相反，后者显示LAI没有优势。考虑到镜像研究中可能存在的偏差，例如期望偏差，自然疾病进程和时间效应，需要谨慎的解释。但是，镜像研究中的人群可以更好地反映临床实践中接受LAI的人群。

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