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Fluphenazine Decanoate (Depot) and Enanthate for Schizophrenia (Review)

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Fluphenazine Decanoate (Depot) and Enanthate for Schizophrenia (Review) Fluphenazine decanoate (depot) and enanthate for schizophrenia (Review) Maayan N, Quraishi SN, David A, Jayaswal A, Eisenbruch M, Rathbone J, Asher R, Adams CE This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2015, Issue 2 http://www.thecochranelibrary.com Fluphenazine decanoate (depot) and enanthate for schizophrenia (Review) Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 6 OBJECTIVES ..................................... 6 METHODS ...................................... 6 RESULTS....................................... 11 Figure1. ..................................... 13 Figure2. ..................................... 16 Figure3. ..................................... 17 ADDITIONALSUMMARYOFFINDINGS . 24 DISCUSSION ..................................... 30 AUTHORS’CONCLUSIONS . 32 ACKNOWLEDGEMENTS . 33 REFERENCES ..................................... 33 CHARACTERISTICSOFSTUDIES . 50 DATAANDANALYSES. 160 Analysis 1.1. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 1 Death. 170 Analysis 1.2. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 2 Global state: 1. Relapse. 171 Analysis 1.3. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 3 Global state: 2. GAS (short term - 6 weeks to 5 months) (high score = worse). 172 Analysis 1.4. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 4 Leaving the study early. 173 Analysis 1.5. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 5 Mental state: 1. BPRS (endpoint scores - high score = worse). 174 Analysis 1.6. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 6 Mental state: 2. Depression (mediumterm-6monthsto1year).. 174 Analysis 1.7. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 7 Adverse effects: 1. Movement disorders - tardive dyskinesia (longer term - more than 1 year).................. 175 Analysis 1.8. Comparison 1 FLUPHENAZINE DECANOATE vs PLACEBO, Outcome 8 Adverse effects: 2. Toxicity. 175 Analysis 2.1. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 1 Global state: 1. No clinically important global change. 176 Analysis 2.2. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 2 Global state: 2. Relapse..................................... 177 Analysis 2.3. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 3 Global state: 3. Clinical Global Impression (short term - 6 weeks to 5 months) (high score = worse). 178 Analysis 2.4. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 4 Leaving the studyearly.................................... 179 Analysis 2.5. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 5 Behaviour: 1. NOSIE-30 - endpoint scores (high score = poor). 180 Analysis 2.7. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 7 Mental state: 1. BPRS - endpoint scores (longer term - more than 1 year) (high score =poor).. ... ... ... .. 181 Analysis 2.8. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 8 Mental state: 2. Depression. .................................. 182 Analysis 2.9. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 9 Adverse effects: 1a.Movementdisorders-general. 183 Analysis 2.10. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 10 Adverse effects: 1b. Movement disorders - akathisia. .......... 184 Analysis 2.11. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 11 Adverse effects: 1c. Movement disorders - needing anticholinergic drugs. ................ 185 Fluphenazine decanoate (depot) and enanthate for schizophrenia (Review) i Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 2.12. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 12 Adverse effects: 1d. Movement disorders - tardive dyskinesia. ............... 186 Analysis 2.13. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 13 Adverse effects: 1e. Movement disorders - tremor (longer term - more than1year).. 187 Analysis 2.14. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 14 Adverse effects: 1f. Movement disorders - average score (Simpson & Angus, 0 to 5 weeks, high = poor). 187 Analysis 2.15. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 15 Adverse effects: 2. Blurred vision - medium term (6 months to 1 year). .............. 188 Analysis 2.16. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 16 Adverse effects: 3. Toxicity - medium term (6 months to 1 year). .......... 188 Analysis 2.17. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 17 Adverse effects:4.Generaladverseeffects. 189 Analysis 2.18. Comparison 2 FLUPHENAZINE DECANOATE vs ORAL NEUROLEPTICS, Outcome 18 SENSITIVITY ANALYSIS Global state: 2. Relapse. .......... 190 Analysis 3.1. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 1 Death. .................................... 191 Analysis 3.2. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 2 Global state: 1. No clinically important global change. .............. 191 Analysis 3.3. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 3 Globalstate:2.Relapse. 192 Analysis 3.4. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 4 Global state: 3. Severly ill (medium term 6 months to 1 year). ............... 194 Analysis 3.5. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 5 Global state: 4. Needing additional antipsychotic treatment(6monthsto1year). 194 Analysis 3.7. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 7 Global state: 6. Clinical Global Impression. (medium term - 6 monthsto1year). 195 Analysis 3.8. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 8 Global state: 7. Clinical Global Impression - not improved (high score = poor). 196 Analysis 3.9. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 9 Leavingthestudyearly. 197 Analysis 3.10. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 10 Behaviour: 1. NOSIE-30 - endpoint scores (high score = poor). ............. 199 Analysis 3.11. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 11 Mental state: 1. BPRS (endpoint scores - high score = poor). ............. 199 Analysis 3.12. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 12 Mental state: 2. BPRS (endpoint scores 6 months to 1 year - dichotomous data). 200 Analysis 3.13. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 13 Mental state: 3. Depression (6 months to 1 year). ......... 201 Analysis 3.15. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 15 Adverse effects: 1a. Movement disorders - general. ............. 202 Analysis 3.16. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 16 Adverse effects: 1b. Movement disorders - needing anticholinergic drugs. 203 Analysis 3.17. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 17 Adverse effects: 1c. Movement disorders - parkinsonism. ............... 204 Analysis 3.18. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 18 Adverse effects: 1d. Movement disorders - tardive dyskinesia: longer term (more than 1 year). 205 Analysis 3.19. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 19 Adverse effects: 1e. Movement disorders - tremor. ............ 206 Analysis 3.21. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 21 Adverseeffects:2.Blurredvision. 207 Analysis 3.22. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 22 Adverse effects: 3. Dry mouth: longer term (more than 1 year). ............... 208 Fluphenazine decanoate (depot) and enanthate for schizophrenia (Review) ii Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 3.23. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 23 Adverseeffects:4.Generaladverseeffects. .......... 208 Analysis 3.24. Comparison 3 FLUPHENAZINE DECANOATE vs OTHER DEPOT NEUROLEPTICS, Outcome 24 SENSITIVITY ANALYSIS Global state: 2. Relapse. .......... 209 Analysis 4.1. Comparison 4 FLUPHENAZINE DECANOATE - DOSAGE STUDIES - HIGH DOSE vs STANDARD, Outcome 1 Global state: 1. Relapse (medium term - 6 months to 1 year). ............. 210 Analysis 4.2. Comparison 4 FLUPHENAZINE DECANOATE - DOSAGE STUDIES - HIGH DOSE vs STANDARD, Outcome 2 Global state: 2. Needing additional antispsychotic treatment (medium term - 6 months to 1 year). 211 Analysis 4.3. Comparison 4 FLUPHENAZINE DECANOATE - DOSAGE STUDIES - HIGH DOSE vs STANDARD, Outcome 3 Global state: 3. Not improved (medium term - 6 months to1year).. 212 Analysis 4.4. Comparison 4 FLUPHENAZINE DECANOATE - DOSAGE STUDIES - HIGH DOSE vs STANDARD, Outcome 4 Leaving the study early (medium term - 6 months to 1 year). ............. 213 Analysis 4.5. Comparison 4 FLUPHENAZINE DECANOATE - DOSAGE STUDIES - HIGH DOSE vs STANDARD, Outcome 5 Mental state: BPRS endpoint scores (medium term - 6 months to 1 year, high score = poor). 213 Analysis 4.6. Comparison 4 FLUPHENAZINE
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