Question: In adults with psychosis, how effective is paliperidone in managing psychosis and reducing psychotic symptoms?

Answer:

The studies included in this evidence summary indicate no clear differences between the effectiveness of oral paliperidone and other psychotropic medications (risperidone, olanzapine and quetiapine) in reducing psychotic symptoms in patients with schizophrenia. Evidence from two RCTs included in a systematic review also indicated no significant difference between the effectiveness of palperidone palmitate injection and long-acting risperidone injection in reducing psychotic symptoms in patients with schizophrenia. There was some evidence, from one RCT, that paliperidone may be more effective than quetiapine in reducing psychotic symptoms in the very short term (2 weeks) in patients with schizophrenia, who are experiencing acute exacerbations. A systematic review of adverse effects indicated that the adverse effects most frequently experienced by patients treated with paliperidone are extra-pyramidal symptoms, headache, insomnia, somnolence, tachycardia and weight gain.

Further research is needed to fully elucidate the comparative effectiveness of paliperidone and other anti-psychotic medications in reducing psychotic symptoms in adults. In particular a wider range of comparisons is needed and studies should include patients with psychotic symptoms arising from conditions other than schizophrenia (e.g. bipolar disorder).