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Relapse with oral antipsychotics versus long-acting injectable antipsychotics: new paradoxical findings
  1. Thomas H Jobe,
  2. Martin Harrow
  1. Department of Psychiatry, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Thomas H Jobe, thjobe{at}

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What is already known about this topic?

Earlier randomised controlled trials (RCTs) for first-generation antipsychotics (FGA) comparing long-acting injectable antipsychotics (LAIs) to oral antipsychotics (OAPs) suggested FGA-LAIs were superior at preventing relapse. By delivering a full-recommended dose on a continuous basis, LAIs would seem to overcome adherence issues associated with OAPs.1

What does this paper add?

  • Despite non-adherence in some OAP patients, OAP and LAI patients did not differ in relapse rates. This updated review completely overturns the authors' previous meta-analysis.2

  • By improving methodology and including four recent RCTs that used second-generation antipsychotics (SGAs), this updated review completely overturns the authors’ previous meta-analysis, published in 2011, which seemed to support the older belief that LAIs were associated with significantly lower relapse rates than OAPs.2

  • The current 2014 paper added a control for publication bias. In RCTs, conducted prior to 1991, unpublished negative findings were not registered. The positive difference in relapse rates between LAIs and OAPs in these studies may have been an artefact of this …

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  • Competing interests None.