Depot pipothiazine palmitate and undecylenate for schizophrenia.
BACKGROUND
Anti-psychotic drugs are usually given orally but compliance with medication given by this route may be difficult to quantify. The development of depot injections in the 1960s gave rise to extensive use of depots as a means of long-term maintenance treatment. Pipothiazine palmitate is a depot from the phenothiazine family of antipsychotic drugs.


OBJECTIVE
To assess the effects of depot pipothiazine palmitate and undecylenate versus placebo, oral anti-psychotics and other depot antipsychotic preparations for people with schizophrenia in terms of clinical, social and economic outcomes.


METHODS
Relevant trials were identified by searching Biological Abstracts (1982-1998), Cochrane Library (Issue 2, 1998), Cochrane Schizophrenia Group's Register (June 1998), EMBASE (1980-1998), MEDLINE (1966-1998) and PsycLIT (1974-1998). References of all identified trials were also inspected for more studies and industry contacted.


METHODS
All clinical randomised trials focusing on people with schizophrenia where depot pipothiazine palmitate and undecylenate, oral anti-psychotics or other depot preparations were compared.


METHODS
Studies were reliably selected, quality rated and data extracted. For dichotomous data Peto odds ratios (OR) with the 95% confidence intervals (CI) were estimated. Where possible, the number needed to treat statistic (NNT) was calculated. Analysis was by intention-to-treat. Normal continuous data were summated using the weighted mean difference (WMD). Scale data were presented only for those tools that had attained pre-specified levels of quality.


RESULTS
Fourteen studies were included. When pipothiazine palmitate was compared to 'standard' oral antipsychotics no differences were found for outcomes of mental state, study attrition, behaviour and adverse effects (total randomised = 166). Pipothiazine palmitate was compared to other depot preparations in nine studies (n=455). Again no differences were identified for outcomes of global improvement, mental state, study attrition, behaviour and adverse effects.


CONCLUSIONS
Although well-conducted and reported randomised trials are still needed to inform practice (no trial data exists reporting hospital and services outcomes, satisfaction with care and economics) pipothiazine palmitate is a viable choice for clinician and recipient of care. Data suggests it is not different to other depot antipsychotics.
Quraishi
S
S
Department of Psychological Medicine, Guy's, King's and St. Thomas' College School of Medicine, 103 Denmark Hill, London, UK, SE5 8AF. spjuasd@iop.kcl.ac.uk
David
A
A
D000284:Administration, Oral; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D006801:Humans; D010640:Phenothiazines / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D010640:Phenothiazines; C084607:pipothiazine palmitate; C023377:pipothiazine undecylenate