Long-Acting Injectable vs Oral Risperidone for Schizophrenia and Co-Occurring Alcohol Use Disorder

Abstract

ClinicalTrials.gov identifier: NCT00130923.

Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits

“…Very few studies have examined this to date, and of those that have, many had small sample sizes, limited follow-up and did not include newer LAI agents such as PP1M [27][28][29]. One randomized trial of long-acting versus oral risperidone in patients with co-occurring alcohol use disorder (n = 95) did not find evidence to support that the long-acting formulation decreased alcohol consumption or resulted in better symptoms than the oral formulation but did find improvements in adherence associated with LAI [27]. Two small open-label studies have shown improved psychiatric symptoms associated with the use of flupenthixol (a first-generation LAI) in patients with cocaine-related disorders/use (n = 8) [28] and in patients with alcohol dependence (n = 27) [29].…”

How to Best Treat Patients With Schizophrenia and Co-Occurring Alcohol Use Disorder

“…8 Injection site adverse events were not reported in the LAI group, and there were no significant differences in side effects between groups. It should be noted that a large percentage (79%) of subjects overall reported adverse events, confirming that risperidone, like other medications commonly used to treat schizophrenia, has a high side-effect burden, suggesting the need to develop better pharmacologic strategies.…”

What Is the Right Pharmacotherapy for Alcohol Use Disorder in Patients With Schizophrenia?

“…This study's negative finding is quite significant and provides clear guidance to the clinical community: treatment with an antipsychotic medication alone, even when delivered in a highly structured research protocol, does not reduce alcohol use in schizophrenia. Green and colleagues 1 have done an important service to the field by demonstrating this. Theirs is the first prospective randomized controlled trial available that measures the effect of antipsychotic medications on alcohol use in a well-characterized cohort of patients with both schizophrenia and alcohol use disorder.…”

“…Clinicians have few proven psychosocial treatments to treat these comorbid conditions, and they usually have even fewer pharmacologic interventions that are readily available in the treatment settings that serve individuals with schizophrenia. Green and colleagues 1 attempt to address this problem in their noteworthy report in this issue of the Journal. The authors are to be highly commended for successfully conducting a sizable clinical trial in one of the most difficult patient populations imaginable-patients with schizophrenia/schizoaffective disorder and co-occurring alcohol use disorder.…”

“…Conversely, as shown by other investigators, medications for alcohol use disorder probably do not make a major impact on psychotic symptoms, even if they reduce alcohol use. 6,8 Green and colleagues 1 have done a heroic job in executing their large and difficult clinical trial. Their results point to the conclusion that the right pharmacotherapy for alcohol use disorder in schizophrenia spectrum disorder most likely consists of appropriate antipsychotic medication combined with medications that possess specific efficacy in the treatment of alcohol use disorder, ideally combined with alcohol counseling and medication adherence support.…”