Differences in the Effectiveness of Long-Acting Injection and Orally Administered Antipsychotics in Reducing Rehospitalization among Patients with Schizophrenia Receiving Home Care Services

Abstract

The current study explored the differences in the effectiveness of first and second generation long-acting injections and orally administered antipsychotics in reducing the rehospitalization rate among patients with schizophrenia receiving home care services in a medical center in Southern Taiwan. Longitudinal data between 1 January 2006, and 31 December 2015, were collected retrospectively. Patients were classified into three treatment groups: First generation antipsychotic (FGA) long-acting injection (LAI), second generation antipsychotic long-acting injection (SGA) (LAI), and oral antipsychotics. The primary outcomes were the rehospitalization rate and the follow-up time (duration of receiving home care services) until psychiatric rehospitalization. A total of 78 patients with schizophrenia were recruited. The average observation time was about 40 months. The oral treatment group tended to be older with a higher number of female patients and a lower level of education. The FGA treatment group tended to have a higher frequency and duration of hospitalization before receiving home care services. We found no significant differences in the follow-up time or psychiatric rehospitalization rate after receiving home care services among the three treatment groups. We propose that oral and LAI antipsychotics were equally effective when patients received home care services. Our results can serve as a reference for the choice of treatment for patients with schizophrenia in a home care program.

Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia

“…In addition, most published studies of LAIAs are based on Western populations, 8 , 10 , 11 and cannot be generalized to Asian populations, for whom medication preferences, attitudes, and the potential to experience adverse effects of antipsychotics might differ. The few published observational studies of LAIAs from Asia were either from a single medical center with an unrepresentative sample 12 , 13 , 14 , 15 or used an insurance claims database in which confounders could not be well adjusted for. 16 , 17 , 18 , 19 , 20 In addition, few studies reported data on outcomes other than hospitalizations.…”

“…[16][17][18][19][20] In addition, few studies reported data on outcomes other than hospitalizations. [12][13][14][15][16][17][18] Misclassification of exposure is also a major issue in these studies because both people treated with LAIAs alone and those treated with concurrent LAIAs and oral anticoagulants (OAs) were categorized as LAIAs users and compared with people treated with OAs alone. 18,21 Currently, barriers still exist in the clinical use of LAIAs.…”

“…The few published observational studies of LAIAs from Asia were either from a single medical center with an unrepresentative sample or used an insurance claims database in which confounders could not be well adjusted for . In addition, few studies reported data on outcomes other than hospitalizations . Misclassification of exposure is also a major issue in these studies because both people treated with LAIAs alone and those treated with concurrent LAIAs and oral anticoagulants (OAs) were categorized as LAIAs users and compared with people treated with OAs alone …”

Long-Term Treatment With Long-Acting Injectable Antipsychotic in Schizophrenia Patients With and Without Dopamine Supersensitivity Psychosis

“…All of them indicated certain advantages of treatment with LAI: some showed LAIs reduced relapse and rehospitalization rates from treatment with oral antipsychotic(s) before the introduction of LAIs, 24,25 and others showed that they are as effective as oral antipsychotics in preventing relapse in parallel follow-up cohorts. [26][27][28][29] All the reports included relatively high ratio of patients under poor adherence as the main reason for the LAI introduction (ie, 40%-90%). Thus, patients who could be expected to receive benefits from LAI treatment simply through improved adherence were likely to have dominated these study populations.…”

Clinical experience with paliperidone palmitate in a specialty hospital in the Philippines: A short report

“…Similar to the studies done previously 16,17 , we reviewed and abstracted baseline patient data from the medical record of eligible patients (i.e., last/latest recorded data prior to initiation of treatment with paliperidone palmitate) for the following variables: age, sex, place of residence, marital status, duration of illness, medical history, index drug, and date of initiation of treatment. Outcome of treatment was collected through a one-time objective assessment of the patient by a third-party psychiatrist (i.e., not involved in the care of the patient, hereinafter referred to as the "Sub-Investigator") using the Structured Clinical Interview for Symptoms of Remission (SCI-SR), a tool that measures remission based on scores (1=absent, 8=present; a score of <3 in all items maintained over a six-month period indicate remission) on eight items of the Positive and Negative Syndrome Scale 18 .…”