More Evidence Endorses Benefits of Long-Acting Antipsychotics

Pauline Anderson

June 10, 2019

SAN FRANCISCO — Results of new research further highlight the advantages of long-acting injectable antipsychotics (LAIs) over oral medications for patients with severe schizophrenia.

Two studies presented here at the American Psychiatric Association (APA) 2019 annual meeting suggest that use of these agents leads to improved adherence and a reduction in suicide attempts for these patients.

Dr Olaniyi Olayinka

Physicians should be aware of the emerging research underlining the benefits of LAIs, the author of one of the studies, Olaniyi O. Olayinka, MD, resident psychiatrist, Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, New York City, told Medscape Medical News.

"With regard to relapse and readmission rates, the evidence suggests that LAIs have increased efficacy," Olayinka said.

Getting Ahead of the Game

Previous research suggests that, compared to oral antipsychotic medications, LAIs are associated with lower relapse and readmission rates among schizophrenia patients, as well as fewer police arrests and incarcerations.

A retrospective chart review analyzed LAI use among patients with schizophrenia who were admitted to psychiatric units at the Interfaith Medical Center in Brooklyn, New York, from September 1–30, 2017.

During this period, 44% of the 43 eligible patients with schizophrenia received an LAI, which in the United States is about 13%.

The knowledge, attitude, and experience of healthcare providers may help explain the relatively high rate of LAI prescriptions at his center, said Olayinka.

The population served by the hospital is predominantly "underinsured and underserved," and the rate of substance abuse disorder is relatively high among these patients, he noted.

"We see higher rates of medical underadherence; we see higher rates of rehospitalization due to relapse; and it's fair to say that the prevalence of severe mental illness in central Brooklyn is higher," Olayinka said.

Prescribing an LAI allows inpatient psychiatrists to "get ahead of the game" to improve medication adherence, said Olayinka.

Most patients in the study who were prescribed an LAI were male, unemployed, lived in private homes, and were hospitalized for 11–20 days.

The investigators divided patients into those aged 41 years or younger and those older than 41 years. Being younger than 41 years was statistically significantly associated with being prescribed an LAI (P = .036).

Gender, employment status, living arrangement, and co-occurring substance abuse were not significantly associated with receiving an LAI.

About 80% of patients who had a hospital stay longer than 10 days were administered an LAI, but the association was not statistically significant (P = .152).

Fifty-eight percent of the patients who received an LAI had a psychiatric readmission.

A second 10-year follow-up study included 344 patients with severe schizophrenia who were treated in mental health units or in a case-managed community-based program.

Investigators found that treatment with an LAI was clearly effective in improving treatment adherence. The study also showed that suicide attempts were significantly related to being treated with an oral antipsychotic but not with an LAI (P < .001).

Studies show that some physicians are reluctant to prescribe LAIs, René Kahn, MD, PhD, professor and chair, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, told Medscape Medical News while commenting on the findings. "The patients don't mind as much as the doctors," he said.

This may be because there's still some debate as to how much better these formulations are compared to oral drugs.

"Far Superior"

Kahn said there's "clear evidence" from studies in Sweden and Finland, which have large, nation-wide databases of patients with schizophrenia, that LAIs are "by far" superior to oral medications in preventing death, rehospitalization, relapse, and suicide.

However, when LAIs are compared head to head to oral medications, "the advantage is much less clear," he said.

One possible reason for this is that in a clinical trial, patients have more frequent healthcare visits and so may become more compliant to taking oral medications, he said.

The number of available LAIs is growing. Typically, the effects of LAIs last a month, but with newer formulations, effects last 2 months, and some are being developed that are effective for 3 months, said Kahn.

A new trial may help determine how much better LAIs really are. Kahn is the principal investigator for one of the largest studies ever to compare an oral agent (aripiprazole [multiple brands]) with an LAI (paliperidone [Invega, Janssen]). The results from this study should be available within a year, he said.

The investigators and Kahn report no relevant financial relationships.

American Psychiatric Association (APA) 2019: Abstracts 161.3 and 68.2. Presented May 18 and 19, 2019.

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