Tuesday, June 7, 2022

Patients With Schizophrenia Switched Early to LAIs Show Markedly Better Long-Term Outcomes

Patients with schizophrenia who switch from oral antipsychotics to long-acting injectables (LAIs) within the first three years of treatment can reduce their risk of symptom relapse, future rehospitalizations, and mortality. Patients who had been taking oral medications for three years or more prior to switching showed no significant improvements outside of improved medication adherence, according to a study published in the Journal of Clinical Psychiatry

“[I]ncreasing evidence suggests that during the early stages of schizophrenia, a critical time when the disease is most treatable, patients may experience more beneficial effects of LAI treatment,” wrote Su-Chen Fang, Ph.D., of Mackay Medical College in New Taipei City, Taiwan, and colleagues. “These real-world data demonstrated that LAIs in the early stage of treatment of hospitalized patients increased disease control and had long-term benefits.”

Fang and colleagues used Taiwan’s national health insurance database to compile data on over 19,000 people aged 16 to 65 who had a schizophrenia diagnosis, were taking oral antipsychotics, and were hospitalized for acute psychosis between 2002 and 2005. They identified 678 patients who were having a psychotic episode and were switched from oral medication to an LAI during hospitalization; they continued to receive the LAI after discharge.

Of these patients, 312 were switched to an LAI within three years of their first oral antipsychotic prescription (early stage), while 366 were switched following three or more years of oral medication use (late stage). All patients were followed up from their date of hospitalization until the end of the study period (December 31, 2015) or death, whichever came first.

As expected, Fang and colleagues found that all patients who switched to LAIs following hospitalization had better medication adherence, as determined by prescription refill data. In addition, those who switched during the early stage of schizophrenia had a 37% reduced risk of psychiatric rehospitalization, a 42% reduced risk of a psychiatric-related emergency room visit, and a 51% reduced risk of mortality compared with patients who stayed on oral medications. For patients who were switched during the late stage of illness, the risk of mortality of emergency room visits did not decrease, and in fact they showed a slightly increased risk of psychiatric rehospitalization compared with patients who stayed on oral medications.

“Patients in the later stages of schizophrenia, especially those who require hospitalization, may represent a group of patients whose condition is unstable,” Fang and colleagues wrote. “This may partly explain the lack of LAI-mediated protective effects in patients who adopted LAIs in the late stage.”

To read more on this topic, see the Psychiatric News story “Real-World Data Show Patients With Schizophrenia Adhere Better to Clozapine and LAIs.”

(Image: iStock/Pornpak Khunatorn)

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