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

Abstract

Background: Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment. Objective: To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics. Methods: This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed. Results: In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs. Conclusion: Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.

Time‐to‐therapy discontinuation in patients newly diagnosed with schizophrenia initiated on long‐acting injectable versus oral dopamine receptor blocking agents

“…This may result from bias in the recruitment of RCT participants that produces a population more likely to be adherent to treatment (i.e., selecting for participants with less severe disease, fewer comorbidities, superior cognition, and greater motivation) and excludes those more likely to be prescribed LAIs in actual practice (Haddad et al, 2009). Furthermore, RCTs often provide comprehensive follow up that can improve outcomes regardless of pharmacological intervention (Montemagni et al, 2022), which may have contributed to a lack of benefit reported with LAIs in some studies (Kishimoto et al, 2014). Ultimately, the significance of these methodological differences remains unclear as a recent meta-analysis of RCTs and cohort studies demonstrated efficacy of LAIs in reducing risk of hospitalization or relapse compared to oral antipsychotics regardless of study type (Kishimoto et al, 2021).…”

Bacillus Calmette–Guérin Vaccine Attenuates Haloperidol-Induced TD-like Behavioral and Neurochemical Alteration in Experimental Rats

“…This study investigated the neuroprotective property of the BCG vaccine against haloperidol-induced TD-like orofacial dyskinesia and motor abnormalities. Haloperidol is a first-generation typical antipsychotic agent used to manage schizophrenia [33]. However, its long-term use is reported to cause hyperkinetic orofacial dyskinesia, also known as TD [34].…”