Early use of long-acting antipsychotics may cut relapse rate in schizophrenia

In a new study conducted by Su-Chen Fang and team it was shown that during the first three years of therapy, switching to long-acting injectable antipsychotics (LAIs) enhanced antipsychotic adherence, decreased relapses, and lowered long-term mortality. The findings of this study were published in The Journal of Clinical Psychiatry.

Long-acting injectable antipsychotics might help people who need mental hospitalization in the early stages of schizophrenia. Few trials, however, have examined the long-term efficacy of patients who transitioned to LAIs vs those who stayed on oral antipsychotics (OAPs).

As a result, this study was carried out with the goals of treatment for schizophrenia including symptom control, relapse prevention and reduction, and improved quality of life, and patients with schizophrenia who are eligible for LAIAPs should be informed of the treatment benefits compared to OAPs, as well as education, monitoring, and support.

Researchers created a population-based cohort of 19,813 new OAP users with ICD-9-CM–defined schizophrenia who were hospitalized between 2002 and 2005 using the Taiwan National Health Insurance Research Database. There were 678 individuals in this cohort who switched to LAIs throughout their stay. The LAI group was matched to patients on OAPs (n = 678). The LAI cohort was then separated for analysis among individuals who switched to LAIs within three years of starting OAP ("an early stage") and those who switched after three years ("a late stage"). To evaluate the risk of mortality and the number of hospital visits between the two groups, conditional Cox regressions and conditional negative binomial regressions were utilized.

The key findings of this study were as follow:

1. During the 13-year research, 312 patients switched to LAIs during the first three years after starting OAP.

2. All-cause and natural-cause mortality rates were considerably lower in these individuals than in those who stayed on OAPs.

3. The HRs for all-cause and natural-cause mortality were 0.49 and 0.30, respectively.

4. There was no significant reduction in unnatural-cause mortality related to LAIs.

5. Patients who received LAIs had lower rates of rehospitalization, mental hospitalization, and psychiatric emergency department visits than those who continued to take OAPs.

6. The late-stage use of LAIs did not reduce the incidence of recurrence or death.

In conclusion, The findings of this study lend credence to the benefits of early LAI therapy in schizophrenia.

Reference:

Fang, S.-C., Huang, C.-Y., & Shao, Y.-H. J. (2022). Long-term outcomes of early use of long-acting injectable antipsychotics in schizophrenia. The Journal of Clinical Psychiatry, 83(4), 41243. https://doi.org/10.4088/JCP.21r14153