Systematic Review and Meta-Analysis of Lurasidone for the Treatment of Schizophrenia Focusing on Endpoints Related to Treatment Goals

Lurasidone shows comparable efficacy and metabolic effects to other antipsychotics, but evidence of its efficacy for clinical events remains insufficient. This study assessed lurasidone’s efficacy in schizophrenia, focusing on endpoints related to treatment goals, including remission and relapse. We conducted a systematic review and meta-analysis, encompassing direct and indirect comparisons. Searches in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Korean databases identified randomized clinical trials of adult patients with schizophrenia, comparing atypical antipsychotics with other treatments or placebo. Lurasidone was compared with three comparators (quetiapine, olanzapine, and ziprasidone) for six outcomes (response, remission, relapse, discontinuation, weight, and glucose). Direct comparisons were analyzed using random-effects models, with adjusted indirect comparisons when necessary. Risk ratios (RRs) were used as dichotomous variables, and standardized mean differences (SMDs) were used as continuous variables. Out of 375 studies screened, 17 were included after preliminary data extraction. Lurasidone outperformed ziprasidone in response (RR 2.82; 95% confidence interval [CI] 1.05 to 7.56) and quetiapine in remission (RR 1.34; 95% CI 1.03 to 1.74). Lurasidone reduced relapse risk compared to quetiapine (RR 0.42; 95% CI 0.22 to 0.81). No significant differences were observed in discontinuation. Lurasidone decreased short-term weight compared to olanzapine (SMD 0.95 kg; 95% CI 1.18 to 0.72kg) and quetiapine (SMD 0.50kg; 95% CI 0.73 to 0.27kg), and glucose levels compared to olanzapine (SMD 0.39mg/dL; 95% CI 0.61 to 0.17mg/dL). In schizophrenia, lurasidone exhibited enhanced efficacy and safety profiles, including response, remission, relapse, short-term weight, and glucose level.