title: Long-term antipsychotic treatment in schizophrenia: systematic review and network meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  For treatment of patients diagnosed with schizophrenia, comparative long-term effectiveness of antipsychotic drugs to reduce relapses when minimising adverse effects is of clinical interest, hence prompting this review.
  
  
  OBJECTIVE
  To evaluate the comparative long-term effectiveness of antipsychotic drugs.
  
  
  METHODS
  We systematically searched electronic databases for reports of randomised controlled trials (RCTs) of antipsychotic monotherapy aimed at reducing relapse risks in schizophrenia. We conducted network meta-analysis of 18 antipsychotics and placebo.
  
  
  RESULTS
  Studies of 10 177 patients in 56 reports were included; treatment duration averaged 48 weeks (range 4-156). Olanzapine was significantly more effective than chlorpromazine (odds ratio (OR) 0.35, 95% CI 0.14-0.88) or haloperidol (OR=0.50, 95% CI 0.30-0.82); and fluphenazine decanoate was more effective than chlorpromazine (OR=0.31, 95% CI 0.11-0.88) in relapse reduction. Fluphenazine decanoate, haloperidol, haloperidol decanoate and trifluoperazine produced more extrapyramidal adverse effects than olanzapine or quetiapine; and olanzapine was associated with more weight gain than other agents.
  
  
  CONCLUSIONS
  Except for apparent superiority of olanzapine and fluphenazine decanoate over chlorpromazine, most agents showed intermediate efficacy for relapse prevention and differences among them were minor. Typical antipsychotics yielded adverse neurological effects, and olanzapine was associated with weight gain. The findings may contribute to evidence-based treatment selection for patients with chronic psychotic disorders.
  
  
  BACKGROUND
  R.J.B. received grants from the Bruce J. Anderson Foundation and the McLean Private Donors Psychopharmacology Research Fund.
  © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
authors.affiliation: , PhD.
authors.forename: Ying Jiao
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: , MSc (IHTA).
authors.forename: Liang
authors.initials: L
authors.lastname: Lin
authors.affiliation: , MHSc.
authors.forename: Monica
authors.initials: M
authors.lastname: Teng
authors.affiliation: , PhD, Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore, Singapore.
authors.forename: Ai Leng
authors.initials: AL
authors.lastname: Khoo
authors.affiliation: , BPharm, Department of Pharmacy, Institute of Mental Health, Singapore, Singapore.
authors.forename: Lay Beng
authors.initials: LB
authors.lastname: Soh
authors.affiliation: , MD, Department of Health Promotion and Human Behavior, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Clinical Epidemiology, Graduate School of Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Toshiaki A
authors.initials: TA
authors.lastname: Furukawa
authors.affiliation: , MD, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA, International Consortium for Psychotic and Mood Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.affiliation: , BPharm, Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore, Singapore.
authors.forename: Boon Peng
authors.initials: BP
authors.lastname: Lim
authors.affiliation: , MBBS, MMed (Psychiatry), FAMS, Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Kang
authors.initials: K
authors.lastname: Sim