Risperidone (depot) for schizophrenia

Area of Science:

• Psychiatry and Pharmacology
• Clinical Trials and Evidence Synthesis

Background:

• Risperidone is a novel antipsychotic available as a long-acting injectable formulation.
• Schizophrenia treatment often involves managing adherence to oral medications.

Purpose of the Study:

• To evaluate the efficacy and safety of depot risperidone against placebo, other antipsychotics, and no treatment for schizophrenia.
• To assess the resource use, cost, and cost-effectiveness of depot risperidone in schizophrenia management.

Main Methods:

• Systematic review of randomized clinical trials comparing depot risperidone with other treatments.
• Searched Cochrane Schizophrenia Group's Register and other sources up to October 2015.
• Extracted data on relapse, mental state, adverse events, and study attrition; assessed risk of bias and used GRADE for quality assessment.

Main Results:

• Depot risperidone showed no significant difference in relapse or mental state improvement compared to oral risperidone, but had more nervous system disorders versus general oral antipsychotics.
• Compared to oral quetiapine, fewer participants left the study early with depot risperidone, but it was associated with more extrapyramidal symptoms (EPS) and prolactin-related events.
• Depot risperidone showed similar efficacy to oral aripiprazole and olanzapine but with higher rates of prolactin-related events and EPS, respectively, and increased early study withdrawal compared to olanzapine.

Conclusions:

• Depot risperidone may offer an alternative for patients with adherence challenges, potentially without increasing extrapyramidal side effects.
• While comparable to oral risperidone for those who adhere to treatment, its superiority over other antipsychotics requires further investigation.
• The evidence suggests depot risperidone might be more acceptable than placebo, but its overall effectiveness and safety profile relative to other treatments warrant careful consideration.