One-year symptom trajectories in patients with stable schizophrenia maintained on antipsychotics versus placebo: Meta-analysis

Background: As definitions of relapse differ substantially between studies, in investigations involving data aggregation, total scores on clinical rating scales provide a more generalisable outcome. Aims: To compare total symptom trajectories for antipsychotic versus placebo treatment over a 1-year period of maintenance treatment in schizophrenia. Method: Randomised controlled trials with antipsychotic and placebo treatment arms in patients with stable schizophrenia that reported Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale total scores at more than one time point were included. Meta-regression analyses were employed using a mixed model. Results: A total of 11 studies involving 2826 patients were included. Meta-regression analyses revealed significant interactions between group and time (Ps<0.0001); both standardised total scores and per cent score changes remained almost unchanged in patients continuing antipsychotic treatment, whereas symptoms continuously worsened over time in those switching to placebo treatment. Conclusions: When considering long-term antipsychotic treatment of schizophrenia, clinicians must balance symptomatic and functional outcomes.