Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia

Abstract

Key Points Question Are long-acting injectable antipsychotics (LAIAs) associated with a lower risk of disease relapse, health care use, and adverse events compared with oral antipsychotics among people in Hong Kong with schizophrenia? Findings In this 16-year, population-based, self-controlled case series study of 70 396 individuals with a diagnosis of schizophrenia, 23 719 were prescribed LAIAs and oral antipsychotics. There were 48% fewer psychiatric hospitalizations, 47% fewer hospitalizations for schizophrenia, 44% fewer suicide attempts, and 37% fewer all-cause hospitalizations during full treatment periods with LAIAs alone, without an increased risk of adverse events; this association was also observed when excluding the first 90 days of treatment. Meaning This study suggests that clinicians should more broadly consider the long-term use of LAIAs for people with schizophrenia.

Improving Outcomes in Schizophrenia—A Case for Initiation of Long-Acting Antipsychotics in Early-Phase Illness

“…4 For example, 1 multisite RCT of 489 individuals with schizophrenia with less than 5 years of lifetime antipsychotic exposure found treatment with once-monthly long-acting injection of aripiprazole to be associated with a significant delay in time to initial psychiatric hospitalization during the 2-year follow-up period compared with treatment as usual. 5 The reduction in suicide attempts observed by Wei et al 3 during LAIA treatment compared with OA treatment has critical implications for reducing the mortality gap among individuals living with schizophrenia and other related disorders. 1 Individuals with schizophrenia are at a heightened risk of death by suicide compared with the general population.…”

“…Emerging evidence supports the initiation of LAIAs within the first 2 years of illness to alter the disease trajectory in this chronic and often disabling illness, but further study across geographic regions and patient populations is needed. 3,4,7 Given the significant prognostic implications, there is a critical need for additional research in populations experiencing a first episode of psychosis to explore the use of LAIA as a first-line pharmacologic treatment, regardless of the perceived level of adherence to an OA. Further research on the effectiveness and tolerability of individual LAIA formulations in early psychosis is essential to guide shared decision-making between clinicians and patients during the critical early years of psychotic illness.…”

“…In a case series study of 70 396 individuals with schizophrenia, Wei et al 3 found a lower risk of suicide attempts, all-cause hospitalizations, and psychiatric hospitalizations associated with longacting injectable antipsychotic (LAIA) treatment compared with oral antipsychotic (OA) treatment.…”

“…The study by Wei et al 3 adds to an existing body of work supporting both the safety of LAIAs and the superior effectiveness of LAIA treatment compared with OA treatment in reducing hospitalizations for acute psychosis among individuals with schizophrenia. A 2021 systematic review and comparative meta-analysis by Kishimoto et al 4 that included 397 319 patients found no significant differences in the risk of extrapyramidal symptoms and most adverse events between LAIA and OA treatment.…”

“…Furthermore, the highly selective inclusion criteria of many RCTs may also exclude clinical subgroups of patients with schizophrenia based on demographic or clinical factors associated with nonadherence, such as active substance use. Wei et al 3…”