Studies Point to Benefits of Early Treatment With Long-Acting Antipsychotics

Abstract

Back to table of contents Previous article Next article Clinical & ResearchFull AccessStudies Point to Benefits of Early Treatment With Long-Acting AntipsychoticsNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:23 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.10.39AbstractPatients with schizophrenia who were prescribed oral antipsychotics for less than three years saw greater symptom improvements when switching to long-acting injectable formulations than those who had been taking the oral medications longer.iStock/Rawf8Numerous studies have pointed to the benefits of long-acting injectable antipsychotics (LAIs) at reducing the risk of symptom relapse, hospitalizations, and other adverse outcomes in patients with schizophrenia. A pair of recent studies provide evidence that switching from oral antipsychotics to LAIs within the first two to three years of a diagnosis may provide the greatest benefit.One study involved data collected from Taiwan’s national health insurance on over 19,000 people aged 16 to 65 who had a schizophrenia diagnosis, were taking oral antipsychotics, and were hospitalized for acute psychosis between 2002 and 2005. Among this group, Joni Yu-Hsuan Shao, Ph.D., a professor of biomedical informatics at Taipei Medical University in Taiwan, and colleagues identified 678 patients who were switched from oral antipsychotics to an LAI during hospitalization and who continued to receive the LAI at least 12 months after discharge; 312 received LAIs within three years of their first oral antipsychotic prescription (early stage of treatment), while 366 transitioned following three or more years of oral medication use (late stage of treatment).As described in the Journal of Clinical Psychiatry, each of these patients was matched to a patient of similar age, sex, hospitalization date, and psychiatric comorbidities who continued taking oral antipsychotics following discharge from the hospital. All patients were followed up from their date of hospitalization until the end of the study period (December 31, 2015) or death, whichever came first. During this period the researchers recorded all instances of rehospitalizations (psychiatric or other medical), psychiatric emergency room (ER) visits, or death.Early LAI switchers had the following:37% reduced risk of psychiatric hospitalization.44% reduced risk of any hospitalization.42% reduced risk of a psychiatric ER visit.51% reduced risk of death by any cause.The reductions in adverse health outcomes were not seen in patients who were switched during the late stage of illness; in fact, patients who switched to LAIs in the late stage of treatment had a 34% increased risk of psychiatric rehospitalization during the follow-up period compared with patients who stayed on oral antipsychotics.“These real-world data demonstrated that LAIs in the early stage of treatment of hospitalized patients increased disease control and had long-term benefits,” Shao and colleagues wrote.The other study was published in JAMA Network Open and conducted by Yue Wei, M.P.H., of the University of Hong Kong and colleagues. The investigators used health records data to identify 23,719 individuals diagnosed with schizophrenia between 1993 and 2019 who were prescribed at least one oral and LAI antipsychotic during this time. They compared the health outcomes of these patients during periods while taking oral antipsychotics with periods while taking LAIs.As expected, patients had lower rates of emergency department visits, hospitalizations, and suicide attempts while taking an LAI antipsychotic relative to their time taking an oral antipsychotic. The benefits were more pronounced for those who began taking LAI antipsychotics within two years of a schizophrenia diagnosis; compared with periods they were taking the oral medication, these patients had the following:76% reduced risk of a psychiatric hospitalization.65% reduced risk of any hospitalization.33% reduced risk of an emergency department visit.72% reduced risk of a suicide attempt while on an LAI.Shao said these findings support the critical period hypothesis, which posits that schizophrenia-related deterioration is particularly aggressive in the two to five years after the first episode of psychosis.The Shao study was supported by the Bali Psychiatric Center, Taiwan. The Wei study was supported by The Excellent Young Scientists Fund of the National Natural Science Foundation of China. ■Resources“Long-term Outcomes of Early Use of Long-Acting Injectable Antipsychotics in Schizophrenia”“Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia” ISSUES NewArchived