Long-acting injectable antipsychotics: Six-month follow-up of new outpatient treatments in Bologna Community Mental Health Centres.

Lorenzo Berardi,Emanuele Forcesi,Ippazio Cosimo Antonazzo,Domenico Berardi,Fabrizio De Ponti,Carlo Piccinni,Antonella Piazza,Angelo Fioritti,Emanuel Raschi,Elisabetta Poluzzi

doi:10.1371/journal.pone.0211938

Lorenzo Berardi, Emanuele Forcesi + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0211938

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Journal: PloS one	Publication Date: Feb 15, 2019
Citations: 2	License type: CC BY 4.0

Affiliation: University of Bologna, University of Ferrara

Abstract

PurposeThis study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs).MethodsNew LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively.ResultsAmong the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18–2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47–2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22–4.59), immigration (HR 3.13, 95%CI 1.28–7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01–1.97).ConclusionsPsychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.

Highlights

The long-acting injectable antipsychotics (LAIs) have aroused new interest, especially with the introduction of second generation agents (SGA) in LAI formulations
NICE guidelines recommend that treatment with LAIs should be considered, after oral antipsychotic (AP) medication, for patients with psychosis or schizophrenia who would prefer such treatment after an acute episode or when avoiding covert non-adherence to antipsychotic medication is a clinical priority [2]
The present study aims to provide real-world evidence on LAI treatments in Community Mental Health Centers (CMHCs) of a Northern Italy area from 2010 to 2015

Summary

Introduction

The long-acting injectable antipsychotics (LAIs) have aroused new interest, especially with the introduction of second generation agents (SGA) in LAI formulations. NICE guidelines recommend that treatment with LAIs should be considered, after oral antipsychotic (AP) medication, for patients with psychosis or schizophrenia who would prefer such treatment after an acute episode or when avoiding covert non-adherence to antipsychotic medication is a clinical priority [2]. SGA-LAIs are claimed to have a number of advantages over first-generation long-acting antipsychotics (FGA-LAIs), such as more rapid onset of action [3], prolonged intervals between administrations, better tolerance and lower risk of drug interactions [4, 5]. There is a rising tendency to use LAIs for people with non-schizophrenic conditions, such as bipolar [6], personality and behavioral disorders [7]. A variety of rather expensive SGA-LAIs are marketed and such a large availability is likely to increase substantially LAIs use [8], notwithstanding the wellknown geographical variations in prescription rates [9, 10]

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