OBJECTIVE  To systematically assess the efficacy and safety of long-acting injectable antipsychotic(LAI) treatment for first-episode schizophrenia(FES) or early-phase schizophrenia(EPS).

METHODS Randomized controlled trial(RCT) studies on LAI treatment for FES and EPS were retrieved from CNKI, Wanfang Database, VIP, China Biomedical Literature Database(SinoMed), PubMed, Embase, Cochrane Library, and Clinical Trials databases. The search time limit is from the establishment of the database to June 30, 2023. Two reviewers independently screened and extracted literature according to the inclusion criteria and evaluated the methodological quality of the included studies using the Cochrane Handbook for Systematic Reviews of Interventions 6.3.0. RevMan 5.4 software was used to conduct the meta-analysis.

RESULTS  A total of 6 RCT studies involving 1987 patients were included. The meta-analysis of efficacy showed that compared with the control group, LAI reduced the hospitalization rate in FES or EPS patients(RR=0.70, 95% CI: 0.62−0.79, P<0.00001) and decreased the Positive and Negative Syndrome Scale(PANSS) scores(MD=0.20, 95% CI: 0.00−0.40, P=0.05). There was no statistically significant difference between LAI and the control group in terms of the rates of psychiatric deterioration/relapse and the Clinical Global Impression-Severity(CGI-S) scores. The meta-analysis of safety showed that compared with the control group, LAI increased the risk of psychiatric abnormality occurrence(RR=1.30, 95% CI: 1.08−1.55, P=0.004). There was no statistically significant difference between LAI and the control group in terms of the rates of rhinitis, weight gain, central nervous system inhibition, cardiovascular and endocrine system reactions and extrapyramidal symptoms.

CONCLUSION  LAI is more effective than OAP in FES or EPS patients in reducing hospitalization rate and improving psychiatric symptoms, with comparable safety.