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Abstract
BackgroundFor many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy.MethodsThe STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed.ResultsOf the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past.DiscussionLAIs’ prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs.
Highlights
The problem of non-adherence to medications is a major concern in people with psychotic disorders [1]
Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum
Seventy per cent were prescribed with secondgeneration antipsychotic (SGA) Long-acting intramuscular (LAI)
Summary
The problem of non-adherence to medications is a major concern in people with psychotic disorders [1]. Antipsychotic discontinuation, is associated with poorer outcomes, including recurrent relapses and hospitalizations, higher risk of suicide, and earlier social and functional disability [2,3,4]. This is relevant in early phases of disease, considering that discontinuation is frequent within the first years from the first episode of psychosis (with estimated rates ranging from about 40% to 70%) [5,6], and most of these patients (from about 40% to 60% in most studies) are likely to relapse in the following few years [7,8]. This study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between firstand second-generations LAIs under ordinary clinical practice in Italy
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