Effectiveness of SGA-LAIs on Clinical, Cognitive, and Social Domains in Schizophrenia: Results from a Prospective Naturalistic Study

Abstract

We hypothesized that shifting from oral second-generation antipsychotics (SGA) to their long-acting injectable (LAI) counterpart would be beneficial for the psychopathological, cognitive, social, and general health domains in outpatients suffering from schizophrenia. We aimed to evaluate the prospective usefulness of SGA-LAI treatment by carrying out a head-to-head comparison of two different medications (i.e., aripiprazole monohydrate (Ari-LAI) and paliperidone palmitate 1 and 3 month (PP1M, PP3M)) in a real-world setting, assessing the effectiveness and tolerability of Ari-LAI and PP1M/PP3M over a 15 month follow-up. A total of 69 consecutive individuals affected by schizophrenia were screened for eligibility. Finally, 46 outpatients (29 treated with Ari-LAI, 13 with PP1M, and four with PP3M) were evaluated through clinical, functional, and neuropsychological assessment administrated at baseline and after 3-, 12-, and 15-month follow-up periods. Moreover, periodic general medical evaluations were carried out. We estimated an overall improvement over time on the explored outcomes, without differences with respect to the type of LAI investigated, and with a global 16.4% dropout rate. Our findings suggest that switching from oral SGA to SGA-LAIs represents a valid and effective treatment strategy, with significant improvements on psychopathological, cognitive, social, and clinical variables for patients suffering from schizophrenia, regardless of the type of molecule chosen.

Applying a clinical staging model in patients affected by schizophrenia spectrum disorder

“…In fact, one of the most current topics of debate in the literature is represented by the timing of use, possible therapeutic switch, and the duration of LAI intervention compared to the onset and prognosis of SCZ ( 61 , 62 ). The routine application of a staging application model for SCZ in clinical practice could allow clinicians to optimize LAI both at the time of a new diagnosis and in the event of relapses or medium- to long-term rehabilitation ( 63 , 64 ).…”

Sociodemographic and clinical factors associated with prescription of first- versus second-generation long-acting antipsychotics in incarcerated adult males

“…This aspect contradicts the clinical observation that aripiprazole, olanzapine, risperidone as well as paliperidone LAIs can be considered suitable for relapse prevention in bipolar disorder (Pacchiarotti et al ., 2019). In addition, the higher frequencies of prescriptions of SGA-LAIs in patients with previous experiences with depot medication may reflect the shift to the newest compounds for patients having a predominance of mood or cognitive symptoms (de Filippis et al ., 2023).…”

Peculiarities of personalized selection of antipsychotic drugs for schizophrenia treatment

“…Вибір АП першої лінії базується на призначенні лікарського засобу з найбільш сприятливим неврологічним профілем безпеки, для мінімізації екстрапірамідних симптомів, які можуть поставити під загрозу початок лікування [12]. За даними досліджень, АП другого покоління мають сприятливий вплив на когнітивні функції, а не тільки на позитивні та негативні симптоми шизофренії [13]. Сучасні АП є ефективними в лікуванні шизофренії, але між АП існують незначні відмінності в ефективності щодо основних симптомів, але відмінності в побічних ефектах більш виражені, що дозволяє лікарям збалансувати ризики та переваги ліків [14].…”