Clinicians should more broadly consider the long-term use of long-acting injectable antipsychotics for people with schizophrenia according to a recent study published in the JAMA Network Open.
Evidence for improved clinical outcomes with long-acting injectable antipsychotics (LAIAs) vs oral antipsychotics (OAs) is limited in Asian populations and special patient groups, including older people (>65 years), people with substance use, and early initiators of long-acting injectable antipsychotics.
A study was conducted to compare the risk of disease relapse, health care use, and adverse events associated with the use of long-acting injectable antipsychotics vs oral antipsychotics among people in Hong Kong with schizophrenia.
In this self-controlled case series study, individuals with a diagnosis of schizophrenia who were prescribed long-acting injectable antipsychotics and oral antipsychotics between January 1, 2004, and December 31, 2019, were identified from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Data analysis was conducted from May to August in 2021.
Risk of disease relapse (hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and suicide attempts), health care use (all-cause emergency department visits and hospitalizations), and adverse events (hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms) between the period in which patients were treated with long-acting injectable antipsychotics and the period in which patients were treated with oral antipsychotics were compared using Poisson regression.
Results:
Of the 70 396 individuals with schizophrenia were prescribed both long-acting injectable antipsychotics and oral antipsychotics.
Compared with oral antipsychotics, long-acting injectable antipsychotics were associated with a lower risk of hospitalizations for any cause, hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and incident suicide attempts.
During full treatment with long-acting injectable antipsychotics, there was a reduction in hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms compared with full treatment with oral antipsychotics.
No significant difference was found for emergency department visits.
Similar associations were observed during the subsequent treatment periods (beyond 90 days) and among older people and those with substance use, except for an increased risk of extrapyramidal symptoms among older people when initiating long-acting injectable antipsychotics (first 90 days).
Compared with late initiators, early long-acting injectable antipsychotic initiators had a greater reduction in these outcome events.
Thus, this self-controlled case series study of people in Hong Kong with schizophrenia suggests that long-acting injectable antipsychotics were associated with a lower risk of disease relapse and hospitalization than OAs, without an increased risk of adverse events. Clinicians should more broadly consider the long-term use of long-acting injectable antipsychotics for Chinese people with schizophrenia, especially early in the course of illness.
Reference:
Wei Y, Yan VKC, Kang W, et al. Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia. JAMA Netw Open. 2022;5(7):e2224163. doi:10.1001/jamanetworkopen.2022.24163
Keywords:
Wei Y, Yan VKC, Kang W, association, Long-Acting, Injectable, Antipsychotics, Oral, Antipsychotics, Disease, Relapse, Health, Care, Use, Adverse, Events, Among, People, Schizophrenia, JAMA Netw Open,