Effects of aripiprazole long‐acting injectable antipsychotic on hospitalization in recent‐onset schizophrenia

Abstract

Objective: Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. Methods: This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. Results: Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p ¼ 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). Conclusion: Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socioeconomic healthcare burden. K E Y W O R D S antipsychotic agents, aripiprazole, pragmatic clinical trials as topic, schizophrenia 1 | INTRODUCTION Severe and often debilitating course of schizophrenia significantly affects society as a whole, especially health care and social services (Karlović, Peitl, & Silić, 2019). Data from some countries attribute up to 3% of total health care expenditures, directly and indirectly to schizophrenia (Chong, et al., 2016). The economic burden of schizophrenia in the United States was estimated at $155.7 billion for 2013 and included excess direct health care costs of $37.7 billion (24%), direct non-health care costs of $9.3 billion (6%), and indirect costs of $117.3 billion (76%) compared to individuals without schizophrenia (Cloutier et al., 2016). A substantial proportion of those health care expenditures is attributable to antipsychotic medication (Mahlich, Olbrich, Wilk, Wimmer, & Wolff-Menzler, 2020). However, nonadherence and partial adherence to antipsychotic medication is very common in patients with schizophrenia and has been linked to therapy resistance (Potkin et al., 2020). Poor treatment adherence has also been associated with repeated relapses and increased

Real-world effectiveness of long-acting injectable antipsychotic treatments in a nationwide cohort of 12,373 patients with schizophrenia-spectrum disorders

“…Published data on the real-life effectiveness of aripiprazole LAI have only recently been published [ 36 ]. Three small mirror-image studies have reported findings for aripiprazole LAI that are in agreement with our findings [ 8 , 37 , 38 ]. For example, one study evaluated 148 UK patients (65% with schizophrenia) receiving aripiprazole LAI between 2014 and 2018 and reported >79% reductions in hospitalization number and duration in both fully compliant and partially compliant (≥50% of injections) patients in the 2-year period following LAI initiation [ 8 ].…”

Persistence and adherence to second-generation antipsychotic long-acting injectable medications for schizophrenia: A comparative study in the Australian context

“…Currently, SGA LAIs are infrequently used as first-line therapy. However, Karlovic et al 13 suggest they should be considered for patients with recent-onset schizophrenia (ROS), 14 reporting reduced use of hospital services at 1-year follow-up of ROS patients prescribed aripiprazole.…”

Clinical Experience on the Use of a Single-day, Two-injection Start Initiation Regimen of Aripiprazole Once Monthly in Patients With Schizophrenia in Spain: SaTISfy Study

“…9,10 Several studies have shown that aripiprazole once monthly 400 mg (AOM400) effectively reduced hospitalization time and improved patient functionality. [11][12][13] Its safety profile was assessed in clinical trials that showed good tolerability and a low incidence of AEs. 14 The initial single-injection start regimen consists of a single intramuscular injection with concomitant oral aripiprazole administration for 14 consecutive days to maintain therapeutic drug concentrations.…”

“…Aripiprazole, an atypical antipsychotic agent that acts as a partial agonist at dopamine D 2 receptors, has been proven to be effective and well-tolerated 9,10 . Several studies have shown that aripiprazole once monthly 400 mg (AOM400) effectively reduced hospitalization time and improved patient functionality 11–13 . Its safety profile was assessed in clinical trials that showed good tolerability and a low incidence of AEs 14 .…”