Long-Acting Injectable Antipsychotics for First-Episode Schizophrenia: The Pros and Cons

Borah Kim,Jong-Il Park,Yen Kuang Yang,Sang-Hyuk Lee,Young-Chul Chung

doi:10.1155/2012/560836

Abstract

Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent “at any stage.” Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.

Highlights

Schizophrenia is a chronic disorder characterized by periods of illness alternating with periods of full or partial remission
The primary clinical and psychosocial deterioration associated with schizophrenia occurs within the first 5 years following the onset of the illness, called the critical period [7, 8]
The relapse rate in patients with first-episode schizophrenia is relatively low during the first year of the illness but substantially rises to rates of 53.7% and 74%–81.9% after 2 and 5 years, respectively [9, 10]

Summary

Introduction

Schizophrenia is a chronic disorder characterized by periods of illness alternating with periods of full or partial remission. Previous studies have suggested that LAI antipsychotics may be more effective for maintaining medication adherence [18] and preventing relapse [19] in first-episode schizophrenia compared with oral antipsychotics. In another study conducted at the same site [26], compared with patients treated with oral risperidone or haloperidol, RLAI-treated patients had significantly fewer all-cause discontinuations (26% versus 70% at 24 months), greater symptom reduction according to PANSS total score (−39.7 versus −25.7), higher remission rates (64% versus 40%), lower relapse rates (9.3% versus 42%), and lower extrapyramidal symptoms [27]

Design

Findings

Conclusions