Kishimoto T, et al. - Researchers assessed the long-term effectiveness of second-generation antipsychotics (SGAs) for maintenance treatment in schizophrenia by systematically reviewing and meta-analyzing relevant randomized trials. They identified 59 studies (N=45,787) indicating that none of the SGAs was consistently superior regarding effectiveness and tolerability. For all-cause discontinuation, findings revealed significant superiority of clozapine, olanzapine and risperidone to several other SGAs, while the inferiority of quetiapine to several other SGAs was seen. Regarding psychopathology, the superiority of clozapine and olanzapine to several other SGAs was seen, while the inferiority of quetiapine and ziprasidone to several other SGAs was reported. Compared to several other SGAs risperidone was superior and clozapine was inferior regarding intolerability-related discontinuation. Risperidone and amisulpride led to significantly worse outcome regarding prolactin increase when compared to several other SGAs. Olanzapine was noted to be superior regarding parkinsonism compared to risperidone, without significant differences relating to akathisia. Significantly worse outcomes concerning sedation and somnolence were noted with clozapine and quetiapine than some other SGAs. These findings support tailoring the long-term risk-benefit profiles of specific SGAs to individual patients to optimize maintenance treatment outcomes.