Factors associated with first- versus second-generation long-acting antipsychotics prescribed under ordinary clinical practice in Italy

Abstract

BackgroundFor many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy.MethodsThe STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed.ResultsOf the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past.DiscussionLAIs’ prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs.

Patterns of Management of Patients With Dual Disorder (Psychosis) in Italy: A Survey of Psychiatrists and Other Physicians Focusing on Clinical Practice

“…With regards to the use of long-acting antipsychotics, roughly one-half responded that they use these agents in clinical practice, with clear preference for the use of an atypical agent in this formulation, in line with a recent study recently conducted in Italy ( 28 ). In this regard, a study comparing long-acting injectable formulations of aripiprazole and paliperidone in patients with comorbid psychosis and SUD found that both agents improved clinical status and QoL and reduced substance craving at 1 year ( 29 ).…”

<p>Resilience and recovery style: a retrospective study on associations among personal resources, symptoms, neurocognition, quality of life and psychosocial functioning in psychotic patients</p>

“…Schizophrenia is a mental illness with a huge health and social impact, determining a significant cognitive impairment, and a worsening in psychosocial functioning of people who suffer from it. The improvement of symptomatology due to psychopharmacological therapy, especially second-generation antipsychotics, partially guarantees a better quality of life, and a greater psychosocial functioning in people affected by psychosis;7–10 psychological, psychosocial, and rehabilitative treatments are further elements of an integrated program aimed to achieve functional recovery and social reintegration 11,12. Thus, to identify protective factors against relapses and to study elements promoting symptom remission is one of the goals in the study of schizophrenia treatment.…”

Once-Monthly Long-Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co-occurring Substance Use Disorders: A Multicentre, Observational Study

“…The use of antipsychotics is crucial for the treatment of patients with schizophrenia regardless of whether they have a co-occurrent SUD [12], and treatment with LAI may offer some advantages over oral formulations [12,38] and is preferred by clinicians in routine clinical practice [51][52][53]; however, little is known about the efficacy of LAI antipsychotics for the management of dually diagnosed patients. In addition to its retrospective and uncontrolled design, our study has several limitations; these include the small sample size, especially for evaluating its efficacy in specific subgroups of SUDs; the allowed concomitant use of psychotropics; and the limited information available on outcomes such as sustained abstinence, which are more predictive of the longterm usefulness of this intervention for the management of SUDs.…”