A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use

Rozin, Emily; Vanaharam, Vivek; D'Mello, Dale A.; Palazzolo, Scott; Adams, Cathy

doi:10.1016/j.abrep.2019.100221

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…Sample size varied widely, ranging between 24 [ 50 ] and 45,625 [ 30 ]. The proportion of females in the publications was noticeably lower (10% or less) in studies using data from the VHA and in one chart review study on cannabis users [ 50 ]. Patients’ mean ages among studies using Medicaid data were in the late-thirties and forties, and in the early fifties among studies using VHA data.…”

Section: Resultsmentioning

confidence: 99%

“…Most included studies used a study design that adjusted for differences between study cohorts, which limits the risk of bias due to confounding. Three studies did not report a method of multivariable adjustment, including two retrospective cohort studies [ 50 , 52 ] and one pragmatic trial [ 53 ]. These studies reported on the likelihood of being hospitalized [ 50 , 53 ], the likelihood of having an ER visit [ 53 ], and adherence [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Three studies did not report a method of multivariable adjustment, including two retrospective cohort studies [ 50 , 52 ] and one pragmatic trial [ 53 ]. These studies reported on the likelihood of being hospitalized [ 50 , 53 ], the likelihood of having an ER visit [ 53 ], and adherence [ 52 ]. In all cases, the studies’ point estimates fell within the range of the other studies reporting on these outcomes, and therefore it is unlikely that descriptive studies that did not adjust for confounding materially impacted this review’s conclusions.…”

Section: Discussionmentioning

confidence: 99%

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Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

et al. 2021

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Background Long-acting injectable (LAI) antipsychotics, compared with oral antipsychotics (OA), have been found to significantly improve patient outcomes, including reduced hospitalizations and emergency room (ER) admissions and increased medication adherence among adult patients with schizophrenia. In turn, the clinical benefits achieved may translate into lower economic burden. Real-world evidence of the comparative effectiveness of LAI is needed to understand the potential benefits of LAI outside of the context of clinical trials. This study aimed to provide a comprehensive synthesis of recent published real-world studies comparing healthcare utilization, costs, and adherence between patients with schizophrenia treated with LAI versus OA in the United States. Methods In this systematic literature review, MEDLINE ® was searched for peer-reviewed, real-world studies (i.e., retrospective or pragmatic designs) published in English between January 1, 2010 and February 10, 2020. Comparative studies reporting hospitalizations, ER admissions, healthcare costs, or medication adherence (measured by proportion of days covered [PDC]) in adults with schizophrenia treated with LAI versus OA (or pre-vs post-LAI initiation) in the United States were retained. Random effects meta-analyses were conducted among eligible studies to evaluate the association of LAI versus OA use on hospitalizations, ER admissions, healthcare costs, and treatment adherence. A sensitivity analysis among the subset of studies that compared OA with paliperidone palmitate once monthly (PP1M), specifically, was conducted. Results A total of 1083 articles were identified by the electronic literature search, and two publications were manually added subsequently. Among the 57 publications meeting the inclusion criteria, 25 provided sufficient information for inclusion in the meta-analyses. Compared with patients treated with OA, patients initiated on LAI had lower odds of hospitalization (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.54-0.71, n = 7), fewer hospitalizations (incidence rate ratio [IRR] [95%

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

et al. 2021

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“…Moreover, bearing in mind the role of substance use in the course of early psychosis, especially its association with readmission (Abdel‐Baki et al, 2017; Batalla et al, 2013; Opsal et al, 2011; Puntis et al, 2021; Robinson et al, 2019) and treatment resistance (Bozzatello et al, 2019), it is possible that LAI antipsychotics could play a specific beneficial role in patients with early psychosis and substance use disorders. Some guidelines propose the use of LAI antipsychotics as the preferred treatment for the management of patients with schizophrenia and comorbid substance use disorders (Crockford & Addington, 2017; Hasan et al, 2015), and preliminary observational studies suggest a superiority of LAIs vs. oral antipsychotics in reducing hospitalization in patients with early psychosis and comorbid substance use disorders (Abdel‐Baki et al, 2020; Rozin et al, 2019); therefore, it is also possible that that recommendation could be extended to patients with early psychosis.…”

Section: Discussionmentioning

confidence: 99%

A naturalistic study on the effectiveness of long‐acting antipsychotics in an early intervention program for patients with recent‐onset psychosis

Martín-Muñoz

Acuña

Carrión-Mellado

et al. 2022

Early Intervention Psych

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Aim: To evaluate the impact of long-acting injectable antipsychotics (LAIs) on the risk of hospitalization and the length of hospitalization in the setting of an early intervention program for patients with recent-onset psychosis.Methods: Observational, retrospective study conducted under routine clinical practice conditions. We included all patients admitted from July 2015 to April 2020 to the Early Intervention Program in Psychosis. We analysed the incidence of hospitalization and hospitalization days before and after treatment with LAIs and calculated the incidence rate ratio (IRR). We also compared the outcomes of patients treated with LAIs with those of the patients maintained on oral antipsychotics using a binomial negative regression analysis.Results: A total of 170 patients were included in the program. Of them, 34 (20%) received LAIs (aripiprazole [n = 22], and paliperidone/risperidone [n = 12]). There was an 89% reduction in the incidence of hospitalizations after treatment with LAIs (IRR 0.11, 95%CI 0.05-0.21; p < .0001). The IRR for LAIs vs. oral antipsychotics was 0.87 (95%CI, 0.24-3.18; p = .829). The presence of a substance use disorder significantly increased the rate of hospitalizations by 123% (IRR 2.23,.Analyses of hospitalization days showed similar results.Conclusions: Our results suggest that LAIs are useful for the management of patients with recent-onset psychosis who fail treatment with oral antipsychotics. Whether LAIs are superior to oral antipsychotics as first-line treatment of patients with early psychosis and/or could play a special role in managing patients with early psychosis and comorbid substance use disorders should be further evaluated.

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“…Therefore, it is important that treatment is initiated as soon as possible after the first episode of psychosis, which often occurs during late adolescence and early adulthood [1]. Nonadherence to medication is a major issue when attempting to treat schizophrenia [4][5][6]. Significant predictors of medication nonadherence include substance misuse, depressive symptoms, poor disease insight, and lower occupational status [4,5].…”

Section: Introductionmentioning

confidence: 99%

Long-acting injectable antipsychotics for early psychosis: A comprehensive systematic review

et al. 2022

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Aim Long acting injectable (LAI) antipsychotics are an alternative to oral antipsychotic (OAP) treatment and may be beneficial for patients in the early stages of schizophrenia. This study aims to provide a comprehensive review on the efficacy of first-generation and second-generation LAI antipsychotics in recent-onset, first-episode, and early psychosis patients. Methods MEDLINE, EMBASE, PsycINFO, and Web of Science Core databases were used to search for studies that used LAIs in early psychosis patients. Studies published up to 06 Jun 2019 were included with no language restrictions applied. Inclusion criteria were a diagnosis of schizophrenia or related disorder, where patients were in their first episode or had a duration of illness ≤5 years. Results 33 studies were included: 8 RCTs, 4 post-hoc analyses, 2 case reports, and 19 naturalistic studies. The majority of studies evaluated risperidone LAIs (N = 14) and paliperidone palmitate (N = 10), while the remainder investigated fluphenazine decanoate (N = 3), flupentixol decanoate (N = 2), and aripiprazole (N = 1). Two studies did not specify the LAI formulation used, and one cohort study compared the efficacy of multiple different LAI formulations. Conclusions While the majority of data is based on naturalistic studies investigating risperidone LAIs or paliperidone palmitate, LAIs may be an effective treatment for early psychosis patients in terms of adherence, relapse reduction, and symptom improvements. There is still a need to conduct more high quality RCTs that investigate the efficacy of different LAI formulations in early psychosis patients.

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A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use

Cited by 9 publications

References 15 publications

Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

A naturalistic study on the effectiveness of long‐acting antipsychotics in an early intervention program for patients with recent‐onset psychosis

Long-acting injectable antipsychotics for early psychosis: A comprehensive systematic review

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