Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

Abstract

Aim The aim of this review was to analyze the discontinuation rates during long‐term treatment with second‐generation antipsychotic long‐acting injection (SGA‐LAI) in adults with either schizophrenia spectrum or bipolar disorders. Methods A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (1 January 2001–12 October 2018) identified 1214 abstracts, which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥36 weeks. Data were extracted from 51 articles meeting the inclusion criteria. Results In all head‐to‐head comparisons, and studies on patients with schizophrenia spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA‐LAI was, at best, similar to that recorded in patients treated with first‐generation antipsychotics in either oral or LAI formulations or with oral SGA. In particular, in most of the SGA‐LAI long‐term studies, the rate of premature dropout was higher than 50%. Conclusion Reviewed data suggest that SGA‐LAI show no clear superiority over less expensive drugs (including first‐generation antipsychotic LAI and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long‐term pharmacological treatment regimens.

Aripiprazole Long-Acting Injection During First Episode Schizophrenia—An Exploratory Analysis

“…Antipsychotic treatment results in a good response soon after the first episode, but are associated with low clinical and social recovery rates (around 13.5%) (33). This is due to various factors, as poor treatment adherence tends to establish in most patients in the long run [even with long-acting injectable antipsychotic drugs (LAIs), premature treatment termination is more than 50% (34)] and, even when adherence is ensured, after long-term treatment, 15% of patients will still show symptoms of chronic illness (35). Clearly, the management of illness requires constant care for symptom control, relapse prevention, and psychosocial long-term rehabilitation (3), but mainly focuses on drug treatment, mostly antipsychotic drugs (36,37).…”

Effectiveness and Predictors of Discontinuation of Aripiprazole Long-acting Injection

“…The commonest reason for medication discontinuation in both was patient choice and not inefficacy. Retrospective studies of antipsychotic LAIs generally have a greater discontinuation rate than prospective (randomized or open label) studies at 1 year, as observed in a recent descriptive review, 14 with retrospective studies being more representative of clinical reality. A discontinuation rate of aripiprazole LAI at 1 year of 25% was reported in 2 prospective randomized studies 10,15 and 1 prospective open label study 16 .…”

“…The commonest reason for medication discontinuation in both was patient choice and not inefficacy. Retrospective studies of antipsychotic LAIs generally have a greater discontinuation rate than prospective (randomized or open label) studies at 1 year, as observed in a recent descriptive review, 14 with retrospective studies being more representative of clinical reality. A discontinuation rate of aripiprazole LAI at 1 year of 25% was 20 ; and 27%, Anderson et al 21 Higher 1-year discontinuation rates in retrospective studies are also reported, however, for aripiprazole LAI: 66% in schizophrenia and 64% in bipolar disorder, 22 and for paliperidone LAI: 61%, 23 and a 2-site study in Holland 69% and in Belgium 77%, with apparent stability of rate over different periods sampled.…”

Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study

“…Systematic reviews between SGA-LAIs and FGA-LAIs have focused on mortality risk 41 or discontinuation rates. 42 …”

“…Systematic reviews between SGA-LAIs and FGA-LAIs have focused on mortality risk 41 or discontinuation rates. 42 A more recent systematic review and meta-analysis focused on efficacy and safety found only three trials (n = 459) with direct comparisons of SGA-LAIs versus FGA-LAIs, two of them on psychiatric hospitalizations, concluding for no significant differences between them. 40 In a 12-month open-label rater-blinded RCT, number of hospitalizations were not significantly different between patients (n = 54) receiving LAIrisperidone (31 mg mean monthly dose) and TherapeuTic advances in psychopharmacology those receiving haloperidol-LAI (114 mg mean monthly dose) or fluphenazine decanoate (37 mg mean monthly dosage) in 54 patients.…”