Kamyar Keramatian1, Trisha Chakrabarty1, Lakshmi N Yatham2. 1. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. 2. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. l.yatham@ubc.ca.
Abstract
BACKGROUND: Non-adherence to medications is a major determinant of poor outcome in bipolar disorder. Second-generation long-acting injectable (LAI) antipsychotics help ensure medication adherence which in turn can lead to more favourable outcomes. However, the role of these medications in bipolar disorder is not well established. OBJECTIVE: We sought to review available evidence relating to the efficacy and safety of using second-generation LAI antipsychotics in bipolar disorder. METHODS: PRISMA guidelines were followed to systematically review all clinical studies that reported on the efficacy and safety of second-generation LAI antipsychotics in patients with bipolar disorder. We searched Ovid Medline, PsycINFO, and Cochrane Central Register of Controlled Trials from inception to November 2018. RESULTS: Of 459 identified citations, 53 studies were fully evaluated and 37 met our inclusion criteria. Overall, second-generation LAI antipsychotics were found to be well tolerated and effective for treatment of manic symptoms and preventing mood recurrences in adults with bipolar disorder. However, we found disparity in the evidence available for individual agents. While several randomized controlled trials (RCTs) reported on the use of risperidone LAI in bipolar disorder, we found only one RCT on the use of aripiprazole LAI, and none for use of paliperidone palmitate or olanzapine pamoate (evidence for the former is limited to one observational study and one case series, and for the latter to a single case report). Studies in children and adolescents were restricted to case reports and small open-label studies. CONCLUSION: Second-generation LAI antipsychotics, particularly risperidone and aripiprazole LAI, may be a safe and effective alternative to oral medications in the management of bipolar disorder.
BACKGROUND: Non-adherence to medications is a major determinant of poor outcome in bipolar disorder. Second-generation long-acting injectable (LAI) antipsychotics help ensure medication adherence which in turn can lead to more favourable outcomes. However, the role of these medications in bipolar disorder is not well established. OBJECTIVE: We sought to review available evidence relating to the efficacy and safety of using second-generation LAI antipsychotics in bipolar disorder. METHODS: PRISMA guidelines were followed to systematically review all clinical studies that reported on the efficacy and safety of second-generation LAI antipsychotics in patients with bipolar disorder. We searched Ovid Medline, PsycINFO, and Cochrane Central Register of Controlled Trials from inception to November 2018. RESULTS: Of 459 identified citations, 53 studies were fully evaluated and 37 met our inclusion criteria. Overall, second-generation LAI antipsychotics were found to be well tolerated and effective for treatment of manic symptoms and preventing mood recurrences in adults with bipolar disorder. However, we found disparity in the evidence available for individual agents. While several randomized controlled trials (RCTs) reported on the use of risperidone LAI in bipolar disorder, we found only one RCT on the use of aripiprazole LAI, and none for use of paliperidone palmitate or olanzapine pamoate (evidence for the former is limited to one observational study and one case series, and for the latter to a single case report). Studies in children and adolescents were restricted to case reports and small open-label studies. CONCLUSION: Second-generation LAI antipsychotics, particularly risperidone and aripiprazole LAI, may be a safe and effective alternative to oral medications in the management of bipolar disorder.
Authors: Joseph R Calabrese; Eduard Vieta; Rif El-Mallakh; Robert L Findling; Eric A Youngstrom; Omar Elhaj; Prashant Gajwani; Ronald Pies Journal: Biol Psychiatry Date: 2004-12-15 Impact factor: 13.382
Authors: Lewis L Judd; Pamela J Schettler; Hagop S Akiskal; Jack Maser; William Coryell; David Solomon; Jean Endicott; Martin Keller Journal: Int J Neuropsychopharmacol Date: 2003-06 Impact factor: 5.176
Authors: Eduard Vieta; Evaristo Nieto; Aurea Autet; Adriane R Rosa; José M Goikolea; Nuria Cruz; Pere Bonet Journal: World J Biol Psychiatry Date: 2008 Impact factor: 4.132
Authors: Lakshmi N Yatham; Marcia Kauer-Sant'Anna; David J Bond; Raymond W Lam; Ivan Torres Journal: Can J Psychiatry Date: 2009-02 Impact factor: 4.356
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