When it comes to antipsychotic selection for the maintenance treatment of patients with schizophrenia, tolerability may be the best guide, advised authors of a systematic review and network meta-analysis published in The Lancet.

“As we found no clear differences between antipsychotics for relapse prevention, we conclude that the choice of antipsychotic for maintenance treatment should be guided mainly by their tolerability,” wrote corresponding author Stefan Leucht, MD, of the Technical University of Munich School of Medicine in Germany, and coauthors.

To compare antipsychotic efficacy in adults with nontreatment-resistant schizophrenia, the investigation included 127 randomized controlled trials of a total 32 oral and long-acting injectable (LAI) antipsychotics. Some 100 studies spanning 30 different antipsychotics contributed to the network meta-analysis of the primary outcome: the number of patients who relapsed for each antipsychotic.

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When compared with placebo for relapse prevention, every antipsychotic included in the analysis had a risk ratio less than 1.00, according to the study. Risk ratios ranged from 0.20 for oral paliperidone to 0.65 for oral cariprazine, with moderate-to-low confidence in estimates.

“Generally, we interpret that there was no clear evidence for the superiority of specific antipsychotics in terms of relapse prevention,” researchers wrote, “because most comparisons between antipsychotics included a probability of no difference.”

Reference

Schneider-Thoma J, Chalkou K, Dörries C, et al. 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. Lancet. 2022;399(10327):824-836. doi: 10.1016/S0140-6736(21)01997-8