Long-acting injectable antipsychotics: what, when, and how

Citrome, Leslie

doi:10.1017/s1092852921000249

Cited by 25 publications

(8 citation statements)

References 85 publications

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“…However, patients with early-stage schizophrenia are often non-adherent to oral antipsychotic medication and need continuous and long-term treatment [ 25 – 27 ]. LAI antipsychotics offer a treatment option for such patients to improve daily adherence with comparable efficacy and tolerability [ 28 ]. A recent study evaluated the real-world effectiveness of LAI antipsychotics over oral antipsychotics in a younger age group (18-35 years) of adult US patients with schizophrenia based on the IBM Watson Health MarketScan Medicaid Database [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

Pesa

Lakey

et al. 2022

BMC Psychiatry

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Background Long-acting injectable (LAI) antipsychotics use is associated with improved adherence which can reduce the rate of relapse, hospitalization, and associated costs in patients with schizophrenia. Young adults could be at higher risk of poor adherence, hence use of LAI in this population may offer a benefit but the evidence is limited. This study aimed to compare clinical and economic outcomes before and after the initiation of LAI antipsychotics in commercially insured young adults (18-35 years of age) with schizophrenia. Methods A retrospective claims data study was conducted using the data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) Database. Patients with a continuous enrollment of at least 1-year before and 1-year after the first observed schizophrenia diagnosis (index date) and with the use of ≥1 typical or atypical LAI antipsychotic during the post-index follow-up period were included. A pre-post analysis was conducted to compare relapse rates, healthcare resource utilization, and costs before (from index date to LAI initiation) and after LAI initiation (to end of follow up). Results A total of 2222 patients who initiated LAIs after an index schizophrenia diagnosis were identified. The per patient per month (PPPM) composite relapse event rate (0.109 pre-LAI to 0.073 post-LAI) and hospitalization rate (0.091 to 0.058), all-cause inpatient visits (0.231 to 0.119), and length of stay (2.694 to 1.092 days) significantly decreased from before LAI initiation to after LAI initiation with similar trends seen for mental health and schizophrenia-related measures (all significant; P < 0.0001). All-cause total costs ($4898 to $3078 PPPM) were also decreased after LAI initiation, with similar trends seen for mental health and schizophrenia-related costs (all significant; P < 0.0001). Although medication costs were higher post-LAI period ($311 to $542 PPPM), the cost increase was substantially offset by the decreased costs associated with total healthcare costs. Conclusions Treatment with LAI antipsychotics was associated with a decrease in relapse event rate, healthcare resource utilization, and costs after LAI initiation compared to before LAI initiation in commercially insured young adults with schizophrenia. Treatment with LAIs in young adults with schizophrenia is potentially associated with significant cost savings to commercial payers.

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Section: Discussionmentioning

confidence: 99%

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

Pesa

Lakey

et al. 2022

BMC Psychiatry

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“…The biggest problem in the pandemic was the OLZ-LAI 3-h surveillance model. During the COVID-19 pandemic this was not possible and clinicians refused to risk and to indicate administration at home, or with a shorter interval of monitoring (as the majority of reactions have been reported within the first hour after the injection) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Switch from Olanzapine Long-Acting Injectable to its Oral Equivalent during COVID-19 Pandemic: a Real World Observational Study

et al. 2022

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Schizophrenia is a psychiatric condition with chronic evolution, one of the most disabling diseases. The main cause for the disease’s progression is considered to be the lack of compliance with the treatment. Long-acting injectable antipsychotics (LAIs) are an important treatment option for patients with schizophrenia. Olanzapine long-acting injection (OLZ-LAI) is a pamoate monohydrate salt of olanzapine that is administered by deep intramuscular gluteal injection. The aim of this paper is to report the effects of a sudden and unplanned switch from olanzapine long-acting injectable to oral olanzapine in remitted patients with schizophrenia due to restrictions caused by the COVID-19 pandemic. An observational study conducted in the Clinical Hospital of Psychiatry and Neurology of Brasov, Romania between April 2020 and March 2021. 27 patients with OLZ-LAI were entered into the study. Of 27 cases, 21 patients preferred to be switched to oral olanzapine (77.77%). Only 6 patients continued with the long-acting formulation. The main reason for the initiation of olanzapine pamoate in all the patients was non-adherence to oral medication (80.95%), and the mean age of starting LAI olanzapine was 36.42 years (SD ± 10.09). Within the following 12 months after switching from olanzapine LAI to OA, 15 patients (71.42%) relapsed, and 12 were admitted to the emergency psychiatric unit. The COVID-19 pandemic has brought multiple disservices to current medical practice. Sudden and unplanned switch from olanzapine long-acting formulation to oral olanzapine was followed by the high rate of relapse in remitted schizophrenia.

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“…Las medicaciones de depósito tienen su principal indicación en la falta de adherencia al tratamiento (35). El frecuente uso de medicaciones de depósito Rev Neuropsiquiatr.…”

Section: Discussionunclassified

Polifarmacia antipsicótica y patrones prescriptivos de psicofármacos en internación psiquiátrica de larga estancia: comparación 1995-2009

Gargoloff

Córsico

Reckziegel³

et al. 2022

Rev Neuropsiquiatr

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Objetivos: Identificar cambios de patrones prescriptivos en pacientes con hospitalización psiquiátrica de larga estancia entre los años 1995-2009. Material y métodos: Estudio comparativo transversal de dos censos diarios (15/06/1995 y 14/12/2009) en el Hospital Neuropsiquiátrico Alejandro Korn, Argentina. Se examinaron listas de agentes psicotrópicos prescritos a todos los pacientes de salas de larga estancia. Resultados: Disminución de 33% de admitidos en el censo de 1995 (n=1048) comparado con el de 2009 (n=698), aumento de pacientes varones (44% a 57%) y de internación de mayores de 20 años de duración (29% a 40%). El diagnóstico más prevalente continuó siendo esquizofrenia seguido de retardo mental: 45% y 27%, respectivamente, en 1995, 44% y 33% en 2009. La dosis media de antipsicóticos para esquizofrenia fue similar, alrededor de un equivalente de 760 mg/d de clorpromazina. Pacientes con dosis de antipsicóticos mayores a 1200mg/d de clorpromazina disminuyeron de 28% a 23,9%. En pacientes con problemas de aprendizaje/retardo mental, cerca del 80% recibían antipsicóticos en ambos censos. La polifarmacia antipsicótica aumentó un 6,7% en esquizofrenia (61%), disminuyó 12,6% en retraso mental (45%) y 6,5% en todos los pacientes (49%). Haloperidol y levomepromazina continuaron siendo los antipsicóticos más usados, en tanto que el uso de anticolinérgicos disminuyó en un 21%. En cuanto a drogas sedantes, creció el uso de benzodiazepinas y prometazina (15% y 19% respectivamente), y alrededor del 35% continuó recibiendo levomepromazina. Discusión: La introducción de antipsicóticos atípicos no dio lugar a grandes mejorías en el uso racional de psicofármacos, excepto por la prescripción de menos fármacos antipsicóticos en pacientes con retardo mental, y de anticolinérgicos en la población general. Conclusión: El aumento de polifarmacia antipsicótica en esquizofrenia y del uso de benzodiacepinas subraya la necesidad de una práctica mejor basada en evidencias provenientes de la investigación clínica.

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Long-acting injectable antipsychotics: what, when, and how

Cited by 25 publications

References 85 publications

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

Switch from Olanzapine Long-Acting Injectable to its Oral Equivalent during COVID-19 Pandemic: a Real World Observational Study

Polifarmacia antipsicótica y patrones prescriptivos de psicofármacos en internación psiquiátrica de larga estancia: comparación 1995-2009

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