Effectiveness of long-acting injectable risperidone versus oral antipsychotics in the treatment of recent-onset schizophrenia

Abstract

Long-acting injectable antipsychotics may offer a relevant improvement in treatment adherence in recent-onset psychosis, leading to a decreased rate of hospital readmission, a better rate of clinical remission and improved psychosocial adjustment. The aim of the study was to compare the clinical remission rates, number of hospital readmissions and personal and social functioning after 2 years between patients with recent-onset schizophrenia (<2 years) in treatment with risperidone long-acting injectable (RLAI) and patients with recent-onset schizophrenia receiving oral antipsychotics. This is a case-control study comparing patients with recent-onset schizophrenia who initiated RLAI treatment between 2004 and 2008 (n=26) with a control group matched for age and sex, diagnosed with recent-onset schizophrenia and treated with oral antipsychotics (n=26). Study assessments included sociodemographic variables, the Positive and Negative Syndrome Scale, the Personal and Social Functioning Scale, the number of hospital readmissions and the Andreasen remission criteria. To assess the effect of treatment on each dependent variable, separate generalized estimating equations models were constructed. After 2 years of treatment, and adjusting for educational level, the RLAI group showed a greater reduction in the Positive and Negative Syndrome Scale total scale [mean (SD)=47.7 (12.0) vs. 66.2 (18.5); mean difference =-17.56; 95% confidence interval (CI)=-27.11 to -8.00; P<0.001], as well as in the negative [mean (SD) 14.3 (6.1) vs. 19.4 (6.4); mean difference=-5.02; 95% CI=-8.28 to -1.77; P=0.002] and general psychopathology [mean (SD)=23.4 (6.3) vs. 32.7 (8.1); mean difference=-9.16; 95% CI=-13.3 to -5.03; P<0.001] subscales compared with the oral antipsychotic group. Personal and Social Functioning Scale scores were also higher in the RLAI group [mean (SD)=72.4 (14.8) vs. 59.7 (13.5); mean difference=13.41; 95% CI=5.65-21.18; P<0.001]. Although not statistically significant, there were fewer readmissions (adjusted odds ratio 0.28; 95% CI=0.06-1.35; P=0.114) and more illness remissions (adjusted odds ratio 3.24; 95% CI=0.20-11.93; P=0.077) in the RLAI group. Treatment with RLAI instead of oral antipsychotics in recent-onset schizophrenia might improve clinical symptoms and social functioning. The efficacy of RLAI treatment on remission and readmission rates should be researched further.

Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement

“…However, this practice is not evidence based and there are anecdotal reports that LAIs may be of particular value when used early in the course of illness 16, 23, 26, 27, 28, 29, 30. Recently, a few randomized studies have demonstrated the value of using APs early in the course of schizophrenia 31, 32.…”

Design and Rationale of the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) Study

“…This, in turn, could decrease the likelihood of institutionalization in hospitals and incarceration. Studies comparing long-acting injectable versus oral antipsychotic treatment have provided inconsistent results, [6][7][8][9][10][11][12][13][14][15] with some indication that demonstrating a differential effectiveness among these formulations is better established with a more pragmatic clinical trial design than with one that is more explanatory. [16][17][18][19] With this in mind, we designed the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study (ClinicalTrials.gov identifier: NCT01157351) to compare once-monthly paliperidone palmitate and daily oral antipsychotics in real-world schizophrenia, as defined by subject inclusion criteria, treatment, and outcomes.…”

Risperidone long‐acting injection and 1‐year rehospitalization rate of schizophrenia patients: A retrospective cohort study

“…Risperidone long‐acting injection (RLAI) is the first of its kind for second‐generation antipsychotics. Previous studies examining the safety and efficacy of risperidone in treating patients with schizophrenia included case–control studies, randomized‐controlled trials, and observational studies . In the case–control studies and randomized‐controlled trials, the patients were selected and grouped before being enrolled in the studies.…”

“…Previous studies examining the safety and efficacy of risperidone in treating patients with schizophrenia included case-control studies, randomizedcontrolled trials, and observational studies. [19][20][21][22][23][24][25][26][27] In the case-control studies and randomized-controlled trials, the patients were selected and grouped before being enrolled in the studies. Although these are the studies with the highest methodological quality, they may also have a lower external validity.…”