Review Article
The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis
Correction(s) for this article
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Corrigendum
- Volume 32Issue 4International Journal of Mental Health Nursing
- pages: 1190-1190
- First Published online: May 24, 2023
Chizimuzo T.C. Okoli PhD MPH MSN APRN PMHNP-BC,
Amani Kappi MSN RN,
Tianyi Wang MS,
Andrew Makowski DNP APRN PMHNP-BC,
Andrew T. Cooley MD,
Corresponding Author
Chizimuzo T.C. Okoli PhD MPH MSN APRN PMHNP-BC
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Correspondence: Chizimuzo T.C. Okoli, University of Kentucky College of Nursing, Behavioral Health and Wellness Environments for Living and Learning (BHWELL), Tobacco Treatment Services and Evidence-Based Practice, Eastern State Hospital, 517 College of Nursing Building, Lexington, KY 40536-0232, USA. Email: [email protected]
Search for more papers by this authorAmani Kappi MSN RN
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Search for more papers by this authorTianyi Wang MS
Department of Statistics, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
Search for more papers by this authorAndrew Makowski DNP APRN PMHNP-BC
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Search for more papers by this authorAndrew T. Cooley MD
University of Kentucky College of Medicine, Lexington, Kentucky, USA
Search for more papers by this authorChizimuzo T.C. Okoli PhD MPH MSN APRN PMHNP-BC,
Amani Kappi MSN RN,
Tianyi Wang MS,
Andrew Makowski DNP APRN PMHNP-BC,
Andrew T. Cooley MD,
Corresponding Author
Chizimuzo T.C. Okoli PhD MPH MSN APRN PMHNP-BC
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Correspondence: Chizimuzo T.C. Okoli, University of Kentucky College of Nursing, Behavioral Health and Wellness Environments for Living and Learning (BHWELL), Tobacco Treatment Services and Evidence-Based Practice, Eastern State Hospital, 517 College of Nursing Building, Lexington, KY 40536-0232, USA. Email: [email protected]
Search for more papers by this authorAmani Kappi MSN RN
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Search for more papers by this authorTianyi Wang MS
Department of Statistics, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
Search for more papers by this authorAndrew Makowski DNP APRN PMHNP-BC
University of Kentucky College of Nursing, Lexington, Kentucky, USA
Search for more papers by this authorAndrew T. Cooley MD
University of Kentucky College of Medicine, Lexington, Kentucky, USA
Search for more papers by this authorDeclaration of conflict of interest: The authors have no conflicts of interest to declare.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Cabinet for Health and Family Services, Department for Medicaid Services.
Authorship statement: C. Okoli conceptualized the study, worked on data analysis, and reviewed sections of the paper. A. Kappi and T. Wang analyzed retrieved and screened articles, imputed data, analyzed data for the meta-analysis, and drafted the main sections of the manuscript. A. Makowski and A. Cooley reviewed and revised the manuscript. All authors listed met the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. All authors are in agreement with and hold themselves jointly to the content in the manuscript.
Abstract
Long-acting injectable (LAI) antipsychotic medications may be an important modality of reducing costs, improving symptoms, and fostering quality of life outcomes for those with schizophrenia. Our objective was to systematically review and conduct a meta-analysis of the effectiveness of LAIs compared with oral antipsychotics on medication adherence, symptom remission/relapse, rehospitalization, outpatient visits, emergency department visits, healthcare costs, and social functioning. We performed a systematic search of PsycInfo, CINAHL, PubMed, and Scopus databases to examine studies meeting inclusion criteria prior to August 30th, 2020. Randomized controlled trials, retrospective studies, prospective studies among people with schizophrenia with at least 6-month follow-up data were obtained. Overall effect sizes and associated 95% confidence intervals (CI) were estimated with random-effects modeling. We found 75 articles meeting our inclusion criteria, including 341 730 individuals with schizophrenia. Systematic review results indicated that LAIs compared with orals improved medication adherence (25/29 studies), symptom remission/relapse (10/18 studies), rehospitalizations (26/49 studies), emergency department visits (9/17 studies), medical costs (11/15 studies), and social functioning (5/9 studies); however, LAIs also increased outpatient visits (7/16 studies) and pharmacy costs (10/10 studies). Meta-analytic results of studies with similar outcome measures did not find differences between LAIs and orals in respect to outcomes, except lowering emergency department visits and increasing pharmacy costs. The differences between the results of the narrative synthesis and the meta-analyses were possibly because of the low availability of studies with similar outcomes in the pooled analyses. Our overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia. These findings support clinical practice in encouraging providers to prescribe LAIs when indicated.
Supporting Information
| Filename | Description |
|---|---|
| inm12964-sup-0001-FigureS1-S17.docxWord 2007 document , 161.3 KB |
Figure S1 PRISMA flow chart illustrating the selection strategies of articles for the systematic review. Figure S2 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics in the proportion of patients that had 80% or more Proportion of Days Covered (PDC). Figure S3 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the Drug Attitude Inventory (DAI) scale. Figure S4 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the Positive and Negative Syndrome Scale (PANSS). Figure S5 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the Clinical Global Impressions (CGI) scale. Figure S6 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the mean number of rehospitalizations per patient. Figure S7 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the mean number of outpatient visits per patient. Figure S8 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the mean number of emergency room visits per patient. Figure S9 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the mean number of medical healthcare costs. Figure S10 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using the mean number of pharmacy costs. Figure S11 Forest plot of studies assessing the differences between Long-Acting Injectable (LAI) and oral antipsychotics using mean Personal and Social Performance (PSP) scores. Figure S12 Prediction interval for the dispersion effect size for the PDC outcomes. Figure S13 Prediction interval for the dispersion effect size for the PANSS outcomes Figure S14 Prediction interval for the dispersion of true effect size for the rehospitalization outcomes. Figure S15 Observed and imputed studies by Trim and Fill for the PDC outcomes. Figure S16 Observed and imputed studies by Trim and Fill for the PANSS outcomes. Figure S17 Observed and imputed studies by Trim and Fill for the rehospitalization outcomes. |
| inm12964-sup-0002-AppendixS1.docxWord 2007 document , 20.7 KB | Appendix S1 Search strategy with MeSh terms and keywords. |
| inm12964-sup-0003-AppendixS2.xlsxapplication/excel, 24.7 KB | Appendix S2 Quality appraisal scores for included studies. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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