Clinical benefits and impact of early use of long‐acting injectable antipsychotics for schizophrenia

Abstract

AimResults from clinical trials support the use of oral antipsychotics for treatment of early or first‐episode psychosis in patients with schizophrenia. This paper will review literature on the advantages of early initiation of treatment for schizophrenia and the clinical benefits of early use of long‐acting injectable antipsychotics (LAIs).MethodA comprehensive literature review was conducted to identify published literature on the use of LAIs early in the treatment of schizophrenia.ResultsAlthough there is a higher response rate to initial antipsychotic treatment for a first‐episode of schizophrenia than with subsequent antipsychotic treatment, we have not effectively addressed this issue. Poor adherence to treatment is a primary cause of relapse and rehospitalization in subsequent years and was associated with higher relapse rates resulting in devastating effects and substantial economic burden. The costs of nonadherence were estimated to be $1.48 billion. Thus, a major challenge with the treatment of schizophrenia is changing poor adherence to persistence with antipsychotic therapy. LAIs are known to be at least as effective as oral antipsychotics for treating schizophrenia, and yet are underutilized. Further, LAIs address many of the problems associated with adherence to oral therapy. Recent evidence suggests that LAIs are effective for treating first‐episode psychosis and for early initiation of treatment for schizophrenia.ConclusionAlthough consistent antipsychotic treatment represents a critical part of treatment, a person‐centred approach to treating schizophrenia is essential for all aspects of care, including establishing and maintaining a therapeutic alliance, strengthening shared decision‐making and adherence, and achieving long‐lasting recovery.

Paliperidone Palmitate Once-Monthly Treatment in Recent Onset and Chronic Illness Patients With Schizoaffective Disorder

“…Taken together, these results support the potential value of early intervention with PP1M and are consistent with previous reports (Heres et al, 2014; Kane et al, 2015; Llorca et al, 2013; Subotnik et al, 2015) that patients early in their psychiatric illness are often more responsive to treatment. Furthermore, they add to the growing body of evidence on the effects of PP1M in recently diagnosed schizophrenia patients (Bossie et al, 2011; Fu et al, 2014; Sliwa et al, 2012; Stevens et al, 2016; Zhang et al, 2015), including prospective parallel-group comparisons showing benefits with PP1M compared with daily oral antipsychotic treatment (Alphs et al, 2015; Schreiner et al, 2015). In these patients, the tolerability of PP1M's initiation dosing was similar to oral risperidone (Gopal et al, 2011).…”

Predictive factors of overall functioning improvement in patients with chronic schizophrenia and schizoaffective disorder treated with paliperidone palmitate and aripiprazole monohydrate

“…Our data are consistent with an early introduction of LAIs after psychoses onset, be it schizophrenia or schizoaffective disorder, but the same could be apply in the future for bipolar disorder, as ARI was found to delay time to relapse more than placebo (Calabrese et al, ). Since the first solicitations for using LAIs early in the course of schizophrenia (Stip, Abdel‐Baki, Bloom, Grignon, & Roy, ; Zhornitsky & Stip, ), the appropriateness of starting young patients earlier on LAIs is increasingly advanced (Brugnoli et al, ; Karson, Duffy, Eramo, Nylander, & Offord, ; Lytle, McVoy, & Sajatovic, ; Manchanda et al, ; Stevens, Dawson, & Zummo, ).…”

The Predicted Long-Term Benefits of Ensuring Timely Treatment and Medication Adherence in Early Schizophrenia

“…Our results also suggest that these gains can be augmented by improving adherence to antipsychotic drugs during the early stage of the illness. While not widely available, evidence-based interventions to accelerate treatment entry and improve antipsychotic adherence do exist-these include early intervention services such as CSC, and proadherence interventions such as LAI antipsychotics (Mihalopoulos et al 2009;Stevens et al 2016).…”