Antipsychotics for maintenance treatment should be determined mostly by tolerability: Lancet

The findings of this study were as follow:

1. The search yielded 4157 references, of which 501 references on 127 RCTs of 32 antipsychotics (comprising 18 152 people) were included.

2. The network meta-analysis of the primary outcome included 100 trials with 16 812 individuals and 30 antipsychotics.

3. When compared to placebo, all antipsychotics had risk ratios less than 100, and virtually all had 95% credible intervals (CrIs) eliminating no effect.

4. The RRs for paliperidone oral varied from 020 to 065 (016–114) for cariprazine oral.

5. In general, there was no strong evidence for the superiority of individual antipsychotics in terms of relapse prevention since most antipsychotic comparisons considered the possibility of no change.

In conclusion, from the findings of this study, there is no agreement on which antipsychotic is the most beneficial, its usage should be primarily directed by patient tolerance to adverse effects.

Reference:  

Schneider-Thoma, J., Chalkou, K., Dörries, C., Bighelli, I., Ceraso, A., Huhn, M., Siafis, S., Davis, J. M., Cipriani, A., Furukawa, T. A., Salanti, G., & Leucht, S. (2022). Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. In The Lancet (Vol. 399, Issue 10327, pp. 824–836). Elsevier BV. https://doi.org/10.1016/s0140-6736(21)01997-8

Keywords: Lancet, antipsychotics, schizophrenia, paliperidone, relapse, adverse effects, affective disorder, mental health, injectable, long-acting, injectable, oral, tolerance, relapse, Johannes Schneider-Thoma