{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T20:51:52Z","timestamp":1776977512388,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T00:00:00Z","timestamp":1541894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Non\u2010adherence is a significant problem in bipolar disorder. Second\u2010generation antipsychotics (SGA) long\u2010acting injections (LAIs) may improve adherence in bipolar disorder and may prevent relapses. However, the evidence is limited and conflicting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to evaluate efficacy and safety of SGA LAIs in bipolar disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Systematic review and meta\u2010analysis of randomised controlled trials (RCTs) (\u22656\u00a0months duration) investigating safety and efficacy of SGA LAIs for bipolar disorder. We searched Pubmed, Embase, CINAHL, Cochrane, PsycINFO, LiLACS, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">www.clinicaltrials.gov<\/jats:ext-link> up to October 2016. We also contacted the manufacturers of SGA LAIs. Primary efficacy and safety outcomes were relapse rate and all\u2010cause discontinuation respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total of seven RCTs (n\u00a0=\u00a01192) were included. SGA LAIs show superiority over placebo for study\u2010defined relapse rate (RR\u00a0=\u00a00.58, 95% CI\u00a0=\u00a00.49\u20100.68, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.00001) and all\u2010cause discontinuation (RR\u00a0=\u00a00.72, 95% CI\u00a0=\u00a00.64\u20100.82, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.00001). However, no significant difference was found between SGA LAIs and oral active control for relapse rate (RR\u00a0=\u00a00.92, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.79) and all\u2010cause discontinuation (RR\u00a0=\u00a01.2, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.31). In terms of secondary outcomes, SGA LAIs performed better than placebo in relapse to mania\/hypomania, young mania rating scales (YMRS), clinical global impression\u2010severity (CGI\u2010S), montgomery\u2010asberg depression rating scale (MADRS). There was no significant difference between SGA LAIs and oral active control regarding relapse to mania\/hypomania, YMRS, CGI\u2010S, extra\u2010pyramidal side effects (EPSEs), weight gain. However, the active control performed better than SGA LAIs in relapse to depression, MADRS, and prolactin\u2010related AEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Current evidence is very limited to support the use of SGA LAIs (compared to oral medication) in bipolar disorder. Further high\u2010quality studies, particularly comparing SGA LAIs with active control, are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12707","type":"journal-article","created":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T02:33:06Z","timestamp":1541989986000},"page":"687-696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Second\u2010generation antipsychotic long\u2010acting injections in bipolar disorder: Systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7575-3566","authenticated-orcid":false,"given":"Asta R.","family":"Prajapati","sequence":"first","affiliation":[{"name":"Pharmacy Department Norfolk and Suffolk NHS Foundation Trust Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Wilson","sequence":"additional","affiliation":[{"name":"Research Department Norfolk and Suffolk NHS Foundation Trust Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fujian","family":"Song","sequence":"additional","affiliation":[{"name":"Norwich Medical School University of East Anglia Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Maidment","sequence":"additional","affiliation":[{"name":"School of Life and Health Sciences Aston University Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,11]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Bipolar disorder: assessment and management (Clinical Guideline, CG 185)","author":"National Institute of Health and Care Excellence (NICE)","year":"2014"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116636545"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2007.01059.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.11.1927"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2010.11.020"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.10081224"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60239-6"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.179.4.300"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1192\/apt.11.3.203"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/med\/9780198729471.001.0001","volume-title":"Antipsychotic Long\u2010acting Injections","author":"Haddad P","year":"2016"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12609"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.165.6.827"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.2165\/11631310-000000000-00000"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/08039488.2013.801078"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010237"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.16m11201"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0b013e318237709a"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-5215.2010.00458.x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2009.00761.x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2012.03.004"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2010.01.015"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2007.01054.x"},{"key":"e_1_2_9_24_1","first-page":"237","volume-title":"Jadad scale for reporting randomized controlled trials. 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