Long-Acting Injectable Risperidone in the Treatment of Subjects With Recent-Onset Psychosis

Abstract

Using a long-acting antipsychotic to improve adherence early in the illness may reduce relapse rates and promote sustained remission, thereby improving the long-term outcome of schizophrenia. We assessed whether risperidone long-acting injection (RLAI) could be used safely and effectively in the treatment of recent-onset psychosis. Fifty patients aged 15 to 43 years with newly diagnosed schizophreniform disorder or schizophrenia were treated with RLAI 25 to 50 mg every 2 weeks for 2 years. Thirty-six patients (72%) completed the trial. Of 39 (78%) who showed a clinical response of 50%, 4 relapsed. Thirty-two patients (64%) achieved remission. Mean maximum increase in Extrapyramidal Symptoms Rating Scale total score was 1.4 (95% confidence interval, 0.61-2.10; n = 50); 10 patients required anticholinergic medication, and 1 subject developed persistent dyskinesia. Prolactin levels were elevated in 18 patients, 4 of whom reported possible prolactin-related adverse events. Mean increase in body mass index to last visit for all patients was 4.8 kg/m (SD, 3.8 kg/m). The final RLAI dose was 25 mg for 54% of patients, 37.5 mg for 30%, and 50 mg for 16%. This preliminary study suggests that RLAI was overall well tolerated and appears to be effective in recent-onset psychosis. Further investigation is warranted.

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.…”

Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR): Resultados clínicos del uso de risperidona inyectable de liberación prolongada a dos años de seguimiento

“…37 Parece ser que la prescripción de la RILP para los pacientes graves se asocia con una percepción de mayor eficacia terapéutica; sin embargo, esta misma percepción puede llevar a concepciones erróneas sobre los criterios específicos para la prescripción de RILP, antipsicótico que puede ser empleado incluso en pacientes que no han sido previamente tratados con antipsicóticos. [37][38][39][40] Además, los presentes resultados muestran que la RILP 41,42 mientras que en este estudio se encontró una baja proporción de pacientes que descontinuaron el tratamiento debido a la falta de eficacia.…”

Adherence and Long-Acting Injectable Antipsychotics in Schizophrenia: An Update

“…Thus, it is of no surprise that there have been first clinical trials with the administration of LAI in young patients during early phases of illness (52), or even firstepisode patients (32,53). In the study by Emsley and collaborators (53), fifty newly diagnosed patients with schizophrenia or schizophreniform disorder were administered LAI risperidone.…”

“…In the study by Emsley and collaborators (53), fifty newly diagnosed patients with schizophrenia or schizophreniform disorder were administered LAI risperidone. Two-year treatment was completed by 36 patients (72%); 78% of them achieved 50% symptom reduction, 64% were in remission and 4 relapsed.…”