Abstract
BackgroundCurrent guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies.MethodsA systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs.ResultsEighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970’s, 35.8 years in the 1980’s, 39.3 years in the 1990’s, to 39.5 years in the 2000’s) and gender (male > female).Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively).ConclusionsThis analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome.Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.
Highlights
Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs)
Several studies assessed the prevalence of LAI use among patients with schizophrenia, which ranged from 11.9% to 66.0% [44,45,47,55,57,58,59,60,61]
Because of inconsistencies in reporting the drugs and dosages used in the different studies, it was not possible to perform comparisons regarding the doses of LAIs
Summary
Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). Schizophrenia is a chronic disabling illness with a worldwide lifetime prevalence of about 1% [1] It is characterized by relapses alternating with periods of partial or full remission [2] and poor adherence to antipsychotic treatment, leading to multiple rehospitalizations [3] and increased direct and indirect costs [4,5,6,7,8,9,10,11]. Long-acting injectable antipsychotic drugs (LAIs), introduced for the first time in the 1960’s, demonstrated their benefits by lowering relapse rates and durations of hospitalization [3,12,13,14], the high prevalence and severity of extrapyramidal symptoms (EPS) made it necessary to develop new treatments. The efficacy and safety of LAIs have been well established through several randomized controlled trials and therapy choice criteria for these patients have been published recently [17], categorized by disease severity, patients’ socioeconomic level, and patients’ autonomy
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