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Background As definitions of relapse differ substantially between studies, in investigations involving data aggregation, total scores on clinical rating scales provide a more generalisable outcome. Aims To compare total symptom trajectories for antipsychotic versus placebo treatment over a 1-year period of maintenance treatment in schizophrenia. Method Randomised controlled trials with antipsychotic and placebo treatment arms in patients with stable schizophrenia that reported Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale total scores at more than one time point were included. Meta-regression analyses were employed using a mixed model. Results A total of 11 studies involving 2826 patients were included. Meta-regression analyses revealed significant interactions between group and time ( PS <0.0001); both standardised total scores and per cent score changes remained almost unchanged in patients continuing antipsychotic treatment, whereas symptoms continuously worsened over time in those switching to placebo treatment. Conclusions When considering long-term antipsychotic treatment of schizophrenia, clinicians must balance symptomatic and functional outcomes., Competing Interests: Declaration of interestH.T. has received manuscript fees from Sumitomo Dainippon Pharma. O.A has received speaker's honoraria from Eli Lilly & Company USA, Eli Lilly Canada, Janssen-Ortho (Johnson & Johnson), Lundbeck, Mylan Pharmaceuticals, Novartis, Sepracor Inc. and Sunovion, and consultant fees from BMS, Eli Lilly & Company USA, Eli Lilly Canada, Janssen-Ortho (Johnson & Johnson), Lundbeck, Novartis, Otsuka, Roche, Sepracor Inc. and Sunovion, and research support from Boehringer Ingelheim, Neurocrine Biosciences, Janssen-Ortho (Johnson & Johnson), Otsuka, Pfizer Inc. and Sunovion. G.R. has received research support from Novartis, Medicure and Neurocrine Bioscience, consultant fees from Laboratorios Farmacéuticos ROVI, Synchroneuron and Novartis, and speaker's fees from Novartis., (© The Royal College of Psychiatrists 2017.)