Andrew T Olagunju1,2, Scott R Clark1, Bernhard T Baune1,3,4,5. 1. 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia. 2. 2 Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria. 3. 3 Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia. 4. 4 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia. 5. 5 University Hospital for Psychiatry and Psychotherapy, University of Münster, Münster, Germany.
Abstract
OBJECTIVE: Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. METHODS: We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. RESULTS: A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. CONCLUSION: Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.
OBJECTIVE: Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. METHODS: We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. RESULTS: A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. CONCLUSION: Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.
Authors: Brian Godman; Magdalene Wladysiuk; Stuart McTaggart; Amanj Kurdi; Eleonora Allocati; Mihajlo Jakovljevic; Francis Kalemeera; Iris Hoxha; Anna Nachtnebel; Robert Sauermann; Manfred Hinteregger; Vanda Marković-Peković; Biljana Tubic; Guenka Petrova; Konstantin Tachkov; Juraj Slabý; Radka Nejezchlebova; Iva Selke Krulichová; Ott Laius; Gisbert Selke; Irene Langner; András Harsanyi; András Inotai; Arianit Jakupi; Svens Henkuzens; Kristina Garuolienė; Jolanta Gulbinovič; Patricia Vella Bonanno; Jakub Rutkowski; Skule Ingeberg; Øyvind Melien; Ileana Mardare; Jurij Fürst; Sean MacBride-Stewart; Carol Holmes; Caridad Pontes; Corinne Zara; Marta Turu Pedrola; Mikael Hoffmann; Vasileios Kourafalos; Alice Pisana; Rita Banzi; Stephen Campbell; Bjorn Wettermark Journal: Biomed Res Int Date: 2021-10-11 Impact factor: 3.411