OBJECTIVES: Many antipsychotics drugs are available to prevent relapses in patients with schizophrenia, but most of them are associated with adverse events, such as weight gain. Our objective was to conduct a network meta-analysis (NMA) to compare the clinical efficacy and safety outcomes of the most widely used antipsychotics in schizophrenia.

METHODS: A systematic literature review was conducted in February 2017 to identify randomized controlled trials in schizophrenia involving antipsychotics. A Bayesian NMA was conducted on eight antipsychotics (amisulpride, aripiprazole, haloperidol, lurasidone, olanzapine, quetiapine, risperidone and ziprasidone) and placebo. Outcomes of interest included relapse risk (assessed from 24 to 52 weeks) and weight change from baseline to 26 weeks +/- 4weeks. Vague prior distributions were used. The selection of fixed versus random effects model was based on the Deviance Information Criterion.

RESULTS: After reviewing 1486 references, 26 studies were selected and included in the NMA; 15 for relapse (total 5337 patients) and 16 for weight change (total 4561 patients). Olanzapine and aripiprazole were associated with a significant reduction of risk of relapse versus placebo (hazard ratio [95%CI]: 0.26 [0.15; 0.48] and 0.30 [0.15; 0.57] respectively), results for other antipsychotics were not statistically significant but in favour of active treatments versus placebo: risperidone (HR: 0.49 [0.23; 1.04]), haloperidol (HR: 0.49 [0.15; 1.59]), lurasidone (HR: 0.59 [0.26; 1.28]), quetiapine (HR: 0.62 [0.26; 1.41]), ziprasidone (HR: 0.86 [0.39; 2.14]). Olanzapine was associated with a significant increase in weight compared to placebo (+3.05 kg [1.83; 4.46]). Results for other antipsychotics were not statistically significant (mean difference versus placebo ranged from -1.35kg [-3.04; 0.45] for ziprasidone to +1.74kg [-0.18; 3.72] for quetiapine).

CONCLUSIONS: This NMA suggests that olanzapine performed best for relapse prevention but was associated with weight increase. Aripiprazole has an efficacy similar to olanzapine, without being associated with weight increase.