Comparison of clinical outcomes in patients with schizophrenia following different long-acting injectable event-driven initiation strategies

Abstract

This retrospective study evaluated the benefit of following different long-acting injectable (LAI) initiation strategies based on the timing of behavioral and clinical events among Medicaid beneficiaries with schizophrenia. Adults with schizophrenia initiating oral antipsychotics (OAPs) after 12 months without antipsychotic use or schizophrenia-related inpatient/emergency room (ER) visits (index date) were identified. Patients were categorized into four event-driven LAI initiation strategy cohorts based on observed sequences of behavioral (i.e., OAP adherence) and clinical (i.e., schizophrenia-related inpatient/ER visits) events between index and LAI initiation or censoring—strategy #1: adherent to OAPs without schizophrenia-related inpatient/ER visits; strategy #2: nonadherent to OAPs without schizophrenia-related inpatient/ER visits; strategy #3: one schizophrenia-related inpatient/ER visit; strategy #4: ≥2 schizophrenia-related inpatient/ER visits. Clinical outcomes (i.e., all-cause inpatient/ER visits) were evaluated between OAP initiation and end of follow-up. Comparisons between LAI initiation strategy cohorts were conducted using a dynamic marginal structural model adjusting for baseline characteristics and time-varying confounders. Among 13,444 eligible patients, 13.1%, 53.6%, 15.7%, and 17.6% were following strategies #1–4, respectively; of these, 21.9%, 4.3%, 9.2%, and 6.5% started an LAI (the remaining were censored). Strategy #1 was associated with a greater clinical benefit, with 43%, 69%, and 80% fewer inpatient days (all p < 0.05); and 57%, 59%, and 79% fewer ER visits (all p < 0.01) vs strategies #2–4, respectively; the clinical benefit was also observed for strategy #2 vs #3–4. Therefore, starting an LAI prior to OAP nonadherence or occurrence of a schizophrenia-related inpatient/ER visit was associated with fewer all-cause inpatient days of inpatient stay and ER visits.

Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline

“…37 However, proactive and preventive LAI prescribing may yield even better results. 67,68 B) Suboptimal response at current antipsychotic dose and side effects associated with dose escalation: All continuation strategies appear to be more effective in preventing relapse than discontinuing antipsychotic treatment, with a large risk reduction for continuation at standard doses (RR = 0.37) and antipsychotic switching (RR = 0.44) and a moderate risk reduction for dose reduction (RR = 0.68). Antipsychotic continuation and switching did not differ significantly in relapse prevention, whereas antipsychotic dose reduction was outperformed by both continuation and switching.…”

Psychiatric Nurses’ Knowledge and Practice Barriers to Administering Long-Acting Injectable (LAI) Antipsychotics in Taiwan: A Mixed-Methods Study

“…Moreover, IMI methods can also result in skin irritation or damage after the injection, especially for long-acting antipsychotics that are oil-based [ 20 ]. Complications include subcutaneous lumps or hardening, muscle granulomas, medication seepage at the injection site [ 21 , 22 ], fibrosis, abscess [ 21 ], swelling, edema, redness, tenderness [ 21 , 22 ], and even sciatic nerve injury [ 13 , 15 ].…”

“…Pain at the injection site may discourage patients from using LAIs [ 20 , 25 ]. However, some techniques, such as using a different needle before injection and injecting more slowly, have been shown to help reduce pain intensity [ 26 , 27 ].…”