RESUMO
PURPOSE: Antipsychotics, particularly long-acting injectable (LAI) agents, are associated with decreased all-cause mortality. Antipsychotics are also associated with an increased prevalence of infections. We performed a systematic review and meta-analysis of the risk of infections in patients with schizophrenia treated with LAIs versus placebo. METHODS: We systematically searched PubMed and Food and Drug Administration package inserts for placebo-controlled studies of LAI antipsychotic use in schizophrenia. Random effects meta-analysis calculating odds ratios and 95% confidence intervals for any and site-specific infections were performed. RESULTS: The total study sample consisted of 2559 subjects with schizophrenia, with 867 receiving placebo and 1692 LAI antipsychotics. Long-acting injectable antipsychotic use was associated with a significant 1.75-fold increased odds of any infection versus placebo (2.4% vs 1.5%; odds ratio, 1.75; 95% confidence interval, 1.16-2.66; P = 0.008), although findings for specific infections did not reach statistical significance. The association between LAIs and infection was unrelated to study duration, age, sex, body mass index, and total psychopathology. CONCLUSIONS: Our findings suggest that LAIs are associated with a small, but significant, increased risk of infections. This association may be due to immunomodulatory effects of antipsychotics.