Efficacy Of Long-acting Injectable Antipsychotics Research Articles

A Literature Review on the Efficacy of Injectable Neuroleptics in the Treatment of Schizophrenia

Introduction: Schizophrenia is a chronic brain disorder of which the cause is unknown. This disorder affects less than one percent of the population and involves symptoms such as hallucinations, delusions, disorganization, and negative symptoms. Treatment for schizophrenia is mainly used to alleviate symptoms of schizophrenia, therefore improving their quality of life. Injectable neuroleptics are frequently used in patients with schizophrenia to prevent relapses attributed to nonadherence. This literature review will examine the current and potential future uses of injectable neuroleptics as a treatment for individuals with schizophrenia. Methods: This literature review was assembled using the PubMed, Google Scholar, and Science Direct databases to evaluate the efficacy of injectable neuroleptics for individuals with schizophrenia. Keywords for the search include: “neuroleptics”, “schizophrenia”, “risperidone”, “aripiprazole,” “clozapine”, “long-acting injections”, “treatment”, “clinical trial” as well as additional related keywords. Results: In all of the RCTs identified in the reviewed studies, clozapine was considered the most effective in alleviating symptoms associated with schizophrenia although it did not affect the progression of the disorder. Discussion: The literature discussing various injection neuroleptics has been shown to be safe and effective in treating symptoms of schizophrenia but has not been proven to be effective in the slowing of the progression of schizophrenia. As such, future research in this area would be beneficial to the scientific community. Given the limited number of studies, additional research is needed to assess the efficacy of long-acting injectable antipsychotics in slowing the progression of the disorder. One possible research avenue would involve the examination of a combination therapy of both injectable and oral neuroleptic treatments. Conclusion: Long-acting injectable antipsychotics have been shown to be effective in alleviating many of the debilitating symptoms for individuals with schizophrenia. Further studies are needed to evaluate the most effective method of treating the progression of this disorder, such as combination therapy using both injectable as well as oral antipsychotics.

Preliminary results of a network meta-analysis on the efficacy of long-acting injectable antipsychotics in schizophrenia

IntroductionLong-acting injectable antipsychotics (LAIs) are currently the most effective alternative for patients with schizophrenia who exhibit poor adherence. Although a recent meta-analysis reported similar efficacy between first and second-generation LAIs, these results were only based on 3 studies due to the limited number of head-to-head comparisons.ObjectivesPresent the preliminary results of a network meta-analysis on the comparative efficacy of LAIs in schizophrenia.MethodsStudies were obtained from a previous study, where we carried out a systematic search from until May 2019 in various databases. Included trials of adults with schizophrenia compared the efficacy of LAI vs LAI or placebo through the Positive and Negative Syndrome Scale (PANSS). Efficacy was evaluated through the mean differences (MD) from baseline to endpoint in the PANSS total scores. Network meta-analysis was performed in MetaInsight through direct and indirect comparisons using a Bayesian approach.Resultsfrom 12 studies are presented in Figures 1 and 2. All LAIs except zuclopenthixol were more effective than placebo. There were no significant differences between LAIs except for aripiprazole and risperidone, which were more efficacious than zuclopenthixol. The largest change occurred with aripiprazole LAI, but was not significantly higher than haloperidol.Figure 1. Comparison of treatment pairs. Effect sizes are presented as MD and 95% confidence intervals (*p<0.05).Figure 1. Overall change in symptomsConclusionsPreliminary results from a network meta-analysis also suggest that in the long-term haloperidol decanoate is equally effective in overall symptom changes compared to other LAIs. Further analyses are needed to obtain a better perspective on these drugs.DisclosureNo significant relationships.

Evaluation of Prescribing Patterns of Long-Acting Injectable Antipsychotics Within a Community Health System.

Long-acting injectable antipsychotics (LAIAs) are used in the management of schizophrenia, bipolar disorder, and related psychiatric conditions. The efficacy of LAIAs has been established in randomized controlled trials; however, usage of LAIAs outside of randomized controlled trials may not correlate to naturalistic prescribing habits. The purpose of this analysis was to evaluate the prescribing patterns of LAIAs within our health system and identify any inconsistencies between medications' published labeling information and clinical practice. All patients who received a LAIA at the time of the analysis were included for review. Areas of inconsistency between the prescribed LAIA and each medication's published labeling information were targeted and assessed. Frequency statistics were used to review the following areas for inconsistencies: indication, trial of oral therapy, dose, frequency, and titration method. This analysis included 427 patient cases who received a combined 1480 injections during the analysis period. Overall consistency rates between labeling information and prescribed LAIAs within the analysis period were as follows: 71.2% for indication, 67.4% for trial of oral therapy, 94.4% for dose of LAIA, 84.5% for injection frequency, and 93.9% for titration method. Inconsistencies were observed between labeling information and clinical practice for LAIAs prescribed within the community health system. Patients who are more symptomatic and have additional psychological comorbidities are commonly excluded from clinical trials. Alternative dosing may be clinically necessary to obtain an adequate response, and this may have been captured in this review. This analysis may be hypothesis generating for future studies on LAIAs.

Long Term Efficacy of the Treatment with Olanzapine Pamoate, Risperidone and Aripiprazole Monohydrate

The use of long-acting injectable antipsychotics (LAIs) is considered to be an important treatment option, especially in early stages of schizophrenia. The aim of this study was to evaluate the efficacy, safety and sustained remission in schizophrenia patients treated with three of the available LAIs substances: olanzapine pamoate, risperidone microspheres and aripiprazole monohydrate. A retrospective chart review study evaluating the efficacy of LAIs compared to oral antispychotics during a five years period was performed. Of the 102 patients included in the study, 52 (50.9%) continued LAIs: olanzapine pamoate (n = 20, 38.4%), risperidone microsphere (n = 22, 42.3%), aripiprazole monohydrate (n = 10, 19.3%). In the LAIs group the number of relapses was smaller than in the oral antipsychotics group (12 vs. 23, P [ 0.05) as well as the number of admissions (15 vs. 30, P [ 0.05). In conclusion, relapse in schizophrenia is strongly related to nonadherence. LAIs prescription overall was underutilized despite their efficacy. Future randomized studies are needed to evaluate the long term efficacy of LAIs compared to oral treatment.

Efficacy of Long-Acting Injectable Antipsychotics in Adolescents.

The number of long-acting injectable antipsychotics (LAIA) has increased in recent years. The safety and efficacy of that treatment are not established in children. This study aims to address this gap of information by studying such treatments in a case series. This retrospective chart review of patients identified by the investigators at an academic acute inpatient psychiatric unit included all patients from the past 24 months who required new initial treatment with LAIA. This study included a case series of the nine patients along with Clinical Global Impression-Severity (CGI-S) scores from admission and discharge and Clinical Global Impression-Improvement (CGI-I) scores. Other observations included the presentation of primary psychiatric diagnosis, psychiatric and medical comorbidities, age, sex, previous and LAIA psychiatric medications, reasoning for LAIA treatment, adverse events, CGI-S and CGI-I scores, and outpatient resources utilized to continue treatment. The case series included two females and seven males within the ages of 14-17 years. Of those patients, five were treated with paliperidone palmitate, one treated with risperidone, one treated with fluphenazine, and one treated with aripiprazole. Primary psychiatric diagnosis of the patients in the case series included five with schizophrenia, one with schizoaffective disorder, one with bipolar affective disorder-type I, one with bipolar affective disorder-not otherwise specified, and one with mood disorder-not otherwise specified. In all nine cases, noncompliance was a consideration in treatment with LAIA. Frequent running away and severity of illness were also considerations in one case each. All of the patients required community resources with injectable services. This study describes initiation of treatment with LAIA in 14-17-year olds in an acute inpatient psychiatric unit with serious mental illness. This study also demonstrates the need for outpatient community resources with the ability to provide long-acting injectable medication. Limitations of this study include a small patient population, other factors changing CGI-S and CGI-I scores beyond the medication, and the nature of the study as a retrospective chart review. This study did not compare medications between each other. Maintenance dosing and long-term safety were beyond the scope of this study. Future directives for safety studies, open-label trials, and randomized double-blinded control trails in the pediatric population would be needed.

EPA-0354 - Efficacy and tolerability of long-acting injectable paliperidone palmitate in the treatment of dual psychosis

The efficacy of long-acting injectable antipsychotics in dual schizophrenia patients has been well established. To investigate the efficacy of long-acting injectable paliperidone palmitate(PPLAI) in the psychopathology of dual psychotic patients. To examine the tolerability profile of PPLAI in dual psychosis. An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. We used the Brief Psychiatric Rating Scale (BPRS) to assess psychotic symptoms and the Udvalg für Kliniske Undersogelser Scale (UKU) to evaluate treatment tolerability, at baseline, and after 3 and 6 months of treatment. Prolactin levels were also determined at the time of the study inclusion and after 6 months. Thirty-five patients were included into the study. After 6 months of treatment, patients receiving PPLAI showed a significant improvement in positive symptoms (disorganisation, suspiciousness), negative symptoms (emotional withdrawal, motor retardation, blunted affect and confusion), affective symptoms (somatic concern, anxiety and depression) and in motor symptoms (unco-operativeness, excitement). When compared to the 3rd month assessment, after 6 months, statistically significant differences were found in items 4,11,14,17 and 18. Patients receiving PPLAI had lower rates of side effects assessed by UKU Scale (asthenia, sedation, failing memory, tension, insomnia, rigidity, tremor, weight gain and sexual dysfunction). Baseline prolactin levels ranged 11–122 (mean:38), at 6 months: 20–136 (mean:38.4). After 6 months, patients receiving PPLAI had lower psychotic symptoms, a decrease in side effects, and a significant improvement in global functioning. No changes in prolactin levels were found.

Antipsychotic Formulation and One-Year Rehospitalization of Schizophrenia Patients: A Population-Based Cohort Study

OBJECTIVE The authors compared the efficacy of long-acting injectable antipsychotics and oral antipsychotics on rehospitalization rate of community-dwelling patients with schizophrenia who had frequent admissions. METHODS The cohort study of 14,610 patients was conducted by analyzing the Taiwan National Health Research Institutes data. The patients were divided into groups that received oral antipsychotics (risperidone, a different second-generation antipsychotic, or a first-generation antipsychotic) or long-acting injectable antipsychotics (risperidone, haloperidol, or flupenthixol). RESULTS One-year rehospitalization rates of the final cohort of 10,552 patients were the same for both groups (by long-acting injection, 27.3%; by oral administration, 27.3%). Secondary analysis of groups receiving long-acting injectable medication showed that haloperidol resulted in lower rehospitalization rates (haloperidol, 22.5%; risperidone, 27.1%; and flupenthixol, 29.5%). Patients' characteristics, including age, region, and insurance payments were significantly correlated with the risk of relapse (p<.05). CONCLUSIONS Except for injectable haloperidol, long-acting injectable antipsychotics seem not to be superior to oral antipsychotics in reducing rehospitalization.