Kishimoto T, et al. - In order to ascertain the comparative long-term effectiveness among second-generation antipsychotics (SGAs) in schizophrenia and related disorders, researchers performed this systematic review and meta-analysis of randomized trials. With respect to efficacy and tolerability outcomes, they identified no consistent superiority of any SGA across 59 studies (N=45,787), lasting 47.4±32.1 weeks (range 24-186). They identified significant superiority of clozapine, olanzapine, and risperidone to several other SGAs regarding all-cause discontinuation; quetiapine was identified inferior to several other SGAs. Inferiority of quetiapine and ziprasidone to several other SGAs with respect to psychopathology was seen. Risperidone was identified as superior and clozapine as inferior to several other SGAs concerning intolerability-related discontinuation. Compared to several other SGAs, risperidone and amisulpride were significantly worse concerning prolactin increase. Concerning sedation and somnolence, significantly worse findings were reported with clozapine and quetiapine than some other SGAs. They recommend tailoring the long-term risk-benefit profiles of specific SGAs to individual patients to optimize maintenance treatment outcomes.