Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, New York, USA.
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, New York, USA.
J Clin Psychiatry. 2020 Nov 24;82(1):20r13272. doi: 10.4088/JCP.20r13272.
This systematic review and pooled, patient-level analysis of neuroleptic malignant syndrome (NMS) case reports and series compared NMS characteristics and outcomes during long-acting injectable antipsychotic (LAI) versus oral antipsychotic (OAP) treatment.
Two authors independently searched MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO databases for articles in English from database inception until October 9, 2018.
Case reports with author-defined NMS during ongoing antipsychotic treatment or within 1 injection interval of LAIs in adults aged 18-65 years.
Demographic, clinical, treatment and outcome data were independently extracted following PRISMA guidelines. NMS severity was rated using the Francis-Yacoub scale. Characteristics and outcomes of NMS were compared when occurring during LAI versus OAP treatment, adjusting for significant between-group differences.
Of 662 reported cases (median age = 36 years, male = 61.2%), 122 (18.4%) involved LAIs (second-generation antipsychotic [SGA] LAIs [SGA-LAIs] = 10, 1.5%), whereas 540 (81.6%) involved OAPs (SGA-OAPs = 159, 24.0%). The 2 groups did not differ in age, illness duration, comorbidities, or presence or severity of NMS symptoms (median Francis-Yacoub score: LAIs = 26 vs OAPs = 23, P = .8276). Antipsychotic formulation was not significantly associated with longer duration of hospitalization (LAIs = 5.0 weeks vs OAPs = 3.8 weeks, P = .8322), post-NMS sequelae (LAIs = 8.8% vs OAPs = 7.0%, P = .7489), or death (LAIs = 10.7% vs OAPs = 6.7%, P = .0861). When different, post hoc confounder-adjusted models were used, duration of NMS (but not hospitalization for NMS) was longer with LAIs than with OAPs (median = 2.6 vs 1.8 weeks, P = .0339), driven by FGAs rather than SGAs.
These data, plus the fact that only 10 published NMS cases exist with SGA-LAIs, should mitigate safety concerns regarding LAIs, but results should be interpreted cautiously since they are based on case reports.
本系统评价和汇集的神经阻滞剂恶性综合征（NMS）病例报告和系列研究，比较了长效注射抗精神病药（LAI）与口服抗精神病药（OAP）治疗期间 NMS 的特征和结局。
两名作者独立检索了 MEDLINE、Embase、Cochrane、CINAHL 和 PsycINFO 数据库，检索了从数据库开始到 2018 年 10 月 9 日期间发表的英文文章。
正在接受抗精神病药物治疗期间或 LAI 注射间隔内发生作者定义的 NMS 的病例报告，纳入年龄在 18-65 岁之间的成年人。
按照 PRISMA 指南独立提取人口统计学、临床、治疗和结局数据。使用 Francis-Yacoub 量表评估 NMS 严重程度。比较 NMS 发生在 LAI 与 OAP 治疗时的特征和结局，并对组间显著差异进行调整。
在 662 例报告病例中（中位年龄为 36 岁，男性占 61.2%），122 例（18.4%）涉及 LAI（第二代抗精神病药[SGAs]LAI[SGA-LAIs]为 10 例，占 1.5%），而 540 例（81.6%）涉及 OAP（SGAs-OAPs 为 159 例，占 24.0%）。这两组在年龄、疾病持续时间、合并症或 NMS 症状的存在或严重程度方面无差异（中位 Francis-Yacoub 评分：LAIs = 26 分 vs OAPs = 23 分，P =.8276）。抗精神病药制剂与住院时间延长无显著相关性（LAIs = 5.0 周 vs OAPs = 3.8 周，P =.8322）、NMS 后后遗症（LAIs = 8.8% vs OAPs = 7.0%，P =.7489）或死亡（LAIs = 10.7% vs OAPs = 6.7%，P =.0861）。当使用不同的、事后混杂因素调整的模型时，与 OAP 相比，LAI 治疗的 NMS 持续时间（但不是 NMS 住院时间）更长（中位数=2.6 周 vs 1.8 周，P =.0339），这主要是由 FGAs 而不是 SGAs 驱动的。
这些数据，加上只有 10 例发表的 SGA-LAI 相关 NMS 病例存在，应该减轻人们对 LAI 的安全性担忧，但由于这些结果基于病例报告，因此应谨慎解释。
