Long-acting injectable antipsychotics in clinical practice

For patients with schizophrenia, appropriate use of long-acting injectable antipsychotics lowers the risk of relapse and improves outcomes — but long-acting injectable antipsychotics are underused for a variety of reasons. Their benefits and strategies to address underuse were discussed by an expert at WPA 2021.

The fundamental concept in the treatment of schizophrenia is to prevent relapse, said Professor Nagesh Pai, University of Wollongong, Australia. Each relapse is associated with a decrease in response to treatment and an increase in treatment resistance.1

 

Maintenance antipsychotic drug therapy decreases the risk of relapse

Stopping medication predicts relapse

Four of every five patients with schizophrenia are likely to relapse within the first 4 years of their illness,2 said Professor Pai, and stopping medication is a powerful predictor of relapse. Discontinuing antipsychotic drug therapy increases the risk of first and second relapse almost five times.2

The majority of experts believe that the average patient with schizophrenia in their practices takes only 51% to 70% of prescribed medication.3 Partial adherence is likely to lead to worsening of symptoms leading to an increased risk of relapse and hospitalization and a poorer prognosis.4

 

Long-acting injectable antipsychotics improve outcomes

Patients with schizophrenia have favorable opinions on long-acting injectable antipsychotics

One strategy to address poor adherence is treatment with a long-acting injectable antipsychotic (LAI) to remove the need for daily adherence to oral medication.

Treatment with an LAI improves outcomes, said Professor Pai:

  • After 24 months, LAI reduces the risk of relapse compared with oral antipsychotics5
  • After 12 months, LAI is associated with clinical remission and functional remission in 39–48% of patients and 38–46% of patients, respectively6–8
  • Risk of death is approximately 30% lower compared with oral agents, and second-generation LAIs are associated with the lowest mortality9

Only 22% of psychiatrists discuss long-acting injectable antipsychotics with their patients

Using an LAI early in the course of schizophrenia may offer patients the maximum potential benefit and avoidance of relapse-associated progressive decline, added Professor Pai.

Among patients who have been treated with LAI:

  • 67% report feeling better after the LAI than they felt before
  • 51% considered the LAI to be more effective than other medication
  • 70% felt better supported in their illness as a result of the regular contact with the doctor or nurse who administered the injection10

However, a survey of European psychiatrists found that only 22% of psychiatrists discuss LAIs with their patients.11

After 12 months, 38–46% of patients treated with long-acting injectable antipsychotic experience functional remission

For more on the mismatch in attitudes to LAIs between psychiatrists and patients see here.

 

Strategies to improve appropriate use of long-acting injectable antipsychotics

Education is key to improve outcomes

To address the current underutilization of LAIs and promote their appropriate use, Professor Pai highlighted the need to provide everyone involved in the management of schizophrenia, including patients, with:

  • Education about the real-world impact of nonadherence
  • Education about the real-world impact benefits of LAIs

Support for this Product Theatre session at WPA 2021 was provided by Johnson and Johnson

 

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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Gardner KN, Nasrallah HA. Current Psychiatry. 2015;14:33–45.
  2. Robinson D, et al. Arch Gen Psychiatry. 1999;56:241–7.
  3. Velligan D, et al. J Clin Psychiatry. 2009;70 Suppl 4:1–46.
  4. Keith SJ, Kane, KM. J Clin Psychiatry. 2003;64:1308–15.
  5. Schreiner A, et al. Schizophr Res. 2015;169:393–9.
  6. Bouju S, et al. Poster 619. Presented at 31st ECNP Congress, 6–9 October 2018, Barcelona, Spain.
  7. Savitz AJ, et al. P.3.d.029. Presented at 29th ECNP Congress, 17–20 September 2016, Vienna, Austria.
  8. Garcia-Portilla MP, et al. EP 1170. Presented at 31st ECNP Congress, 6–9 October 2018, Barcelona, Spain.
  9. Taipale H, et al. Schizophr Res. 2018;197:274–80.
  10. Caroli F, et al. Patient Prefer Adherence. 2011;5:165-71.
  11. Maria C, et al. Eur Psychiatry. 2018:48S:S141–2.
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