Second-generation antipsychotic long-acting injections: systematic review

Background Second-generation antipsychotics (SGAs) represent an advance in the long-term management of schizophrenia. Aims To review the available evidence concerning SGA long-acting injections (LAIs). Method A systematic review of the literature was conducted using PubMed. Results Risperidone long-acting injection was the first licensed SGA-LAI compound and is effective in the long-term management of schizophrenia, with a safety profile similar to that of oral risperidone. Olanzapine pamoate has recently been approved in Europe. In terms of efficacy, at injection intervals of up to 4 weeks it appears comparable to oral olanzapine, although the potential for 'post-injection syndrome' (delirium) calls for additional safety considerations. Paliperidone palmitate is currently under review with the licensing authorities. it also affords the potential advantage of monthly dosing. Conclusions More long-term comparisons of SGA-LAIs with oral SGAs as well as with first-generation antipsychotic LAIs are needed. These studies should include cost-effectiveness data.