Long-Acting Injectable Second-Generation/Atypical Antipsychotics for the Management of Bipolar Disorder: A Systematic Re
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SYSTEMATIC REVIEW
Long‑Acting Injectable Second‑Generation/Atypical Antipsychotics for the Management of Bipolar Disorder: A Systematic Review Kamyar Keramatian1 · Trisha Chakrabarty1 · Lakshmi N. Yatham1
© Springer Nature Switzerland AG 2019
Abstract Background Non-adherence to medications is a major determinant of poor outcome in bipolar disorder. Second-generation long-acting injectable (LAI) antipsychotics help ensure medication adherence which in turn can lead to more favourable outcomes. However, the role of these medications in bipolar disorder is not well established. Objective We sought to review available evidence relating to the efficacy and safety of using second-generation LAI antipsychotics in bipolar disorder. Methods PRISMA guidelines were followed to systematically review all clinical studies that reported on the efficacy and safety of second-generation LAI antipsychotics in patients with bipolar disorder. We searched Ovid Medline, PsycINFO, and Cochrane Central Register of Controlled Trials from inception to November 2018. Results Of 459 identified citations, 53 studies were fully evaluated and 37 met our inclusion criteria. Overall, secondgeneration LAI antipsychotics were found to be well tolerated and effective for treatment of manic symptoms and preventing mood recurrences in adults with bipolar disorder. However, we found disparity in the evidence available for individual agents. While several randomized controlled trials (RCTs) reported on the use of risperidone LAI in bipolar disorder, we found only one RCT on the use of aripiprazole LAI, and none for use of paliperidone palmitate or olanzapine pamoate (evidence for the former is limited to one observational study and one case series, and for the latter to a single case report). Studies in children and adolescents were restricted to case reports and small open-label studies. Conclusion Second-generation LAI antipsychotics, particularly risperidone and aripiprazole LAI, may be a safe and effective alternative to oral medications in the management of bipolar disorder.
1 Introduction Bipolar disorder is a chronic and persistent illness, and one of the leading causes of global disability. Oral mood stabilizing medications and second-generation antipsychotics are the mainstay of treatment for bipolar disorder. The results from naturalistic studies indicate that treatment outcomes for many bipolar disorder patients is suboptimal, with as many as half of patients experiencing a mood episode recurrence within the first year after recovery from the first manic episode [1]. A major determinant of poor outcome in bipolar disorder is non-adherence or partial adherence to oral medications, estimated to be present in 10–60% of patients [2, 3]. Oral * Lakshmi N. Yatham [email protected] 1
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
Key Points The extant literature suggests that second-generation long-acting injectable (LAI) antipsychotics, and in particular risperidone or aripiprazole LAI, are a viable and
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