Aymerich Claudia, Salazar de Pablo Gonzalo, Pacho Malein, Pérez-Rodríguez Violeta, Bilbao Amaia, Andrés Lucía, Pedruzo Borja, Castillo-Sintes Idoia, Aranguren Nerea, Fusar-Poli Paolo, Zorrilla Iñaki, González-Pinto Ana, González-Torres Miguel Ángel, Catalán Ana
Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
Biobizkaia Health Research Institute, Barakaldo, Spain.
Mol Psychiatry. 2025 Jan;30(1):263-271. doi: 10.1038/s41380-024-02694-3. Epub 2024 Aug 22.
Patients with schizophrenia receiving antipsychotic treatment present lower mortality rates than those who do not. However, the non-adherence rate is high, which can be partially addressed using long-acting injectable (LAI) antipsychotics. The impact of LAI treatments on all-cause mortality compared to oral antipsychotics remains unclear. To fill that gap, a random effects meta-analysis was conducted to analyze the odds ratio (OR) of all-cause, suicidal, and non-suicidal mortality among patients taking LAI antipsychotics compared to oral antipsychotics (PROSPERO:CRD42023391352). Individual and pooled LAI antipsychotics were analyzed against pooled oral antipsychotics. Sensitivity analyses were performed for study design, setting, and industry sponsorship. Meta-regressions were conducted for gender, age, antipsychotic dose, and race. Seventeen articles, total sample 12,042 patients (N = 5795 oral, N = 6247 LAI) were included. Lower risk of all-cause mortality for patients receiving LAI antipsychotics vs receiving oral antipsychotics was found (OR = 0.79; 95%CI = 0.66-0.95). Statistical significance was maintained when only studies comparing the same LAI and oral antipsychotic were included (OR = 0.79; 95%CI = 0.66-0.95; p = <0.01), as well as for non-suicidal mortality (OR = 0.77: 95%CI = 0.63-0.94; p = 0.01), but not for suicidal mortality (OR = 0.86; 95%CI = 0.59-1.26; p = 0.44). Mortality reduction was more pronounced for LAI antipsychotics in first-episode psychosis (FEP) (OR = 0.79; 95%CI = 0.66-0.96) compared to chronic psychosis. No individual LAI reported statistically significant differences against all pooled oral antipsychotics. LAI antipsychotics are associated with a lower risk of all-cause and non-suicidal mortality in individuals with schizophrenia compared to oral antipsychotics. Better adherence to the medication and health services may explain this difference. Whenever possible, the use of LAIs should be considered from the FEP.
接受抗精神病药物治疗的精神分裂症患者的死亡率低于未接受治疗的患者。然而，不依从率很高，长效注射用（LAI）抗精神病药物可以部分解决这一问题。与口服抗精神病药物相比，LAI治疗对全因死亡率的影响尚不清楚。为了填补这一空白，我们进行了一项随机效应荟萃分析，以分析服用LAI抗精神病药物的患者与口服抗精神病药物的患者相比，全因、自杀和非自杀死亡率的比值比（OR）（国际前瞻性系统评价注册库：CRD42023391352）。将个体和汇总的LAI抗精神病药物与汇总的口服抗精神病药物进行分析。针对研究设计、研究背景和行业赞助进行了敏感性分析。对性别、年龄、抗精神病药物剂量和种族进行了元回归分析。纳入了17篇文章，总样本量为12042名患者（口服组N = 5795，LAI组N = 6247）。结果发现，接受LAI抗精神病药物治疗的患者与接受口服抗精神病药物治疗的患者相比，全因死亡率风险更低（OR = 0.79；95%置信区间 = 0.66 - 0.95）。当仅纳入比较相同LAI和口服抗精神病药物的研究时，统计学显著性得以维持（OR = 0.79；95%置信区间 = 0.66 - 0.95；p < 0.01），非自杀死亡率也是如此（OR = 0.77：95%置信区间 = 0.63 - 0.94；p = 0.01），但自杀死亡率并非如此（OR = 0.86；95%置信区间 = 0.59 - 1.26；p = 0.44）。与慢性精神病相比，LAI抗精神病药物在首发精神病（FEP）中降低死亡率的效果更显著（OR = 0.79；95%置信区间 = 0.66 - 0.96）。没有单个LAI与所有汇总的口服抗精神病药物相比具有统计学显著差异。与口服抗精神病药物相比，LAI抗精神病药物与精神分裂症患者全因和非自杀死亡率风险较低相关。更好地坚持用药和接受医疗服务可能解释了这种差异。只要有可能，从首发精神病阶段就应考虑使用长效注射剂。
