Evaluation of Prescribing Patterns of Long-Acting Injectable Antipsychotics Within a Community Health System

Abstract

Purpose/Background Long-acting injectable antipsychotics (LAIAs) are used in the management of schizophrenia, bipolar disorder, and related psychiatric conditions. The efficacy of LAIAs has been established in randomized controlled trials; however, usage of LAIAs outside of randomized controlled trials may not correlate to naturalistic prescribing habits. The purpose of this analysis was to evaluate the prescribing patterns of LAIAs within our health system and identify any inconsistencies between medications' published labeling information and clinical practice. Methods/Procedures All patients who received a LAIA at the time of the analysis were included for review. Areas of inconsistency between the prescribed LAIA and each medication's published labeling information were targeted and assessed. Frequency statistics were used to review the following areas for inconsistencies: indication, trial of oral therapy, dose, frequency, and titration method. Findings/Results This analysis included 427 patient cases who received a combined 1480 injections during the analysis period. Overall consistency rates between labeling information and prescribed LAIAs within the analysis period were as follows: 71.2% for indication, 67.4% for trial of oral therapy, 94.4% for dose of LAIA, 84.5% for injection frequency, and 93.9% for titration method. Implications/Conclusions Inconsistencies were observed between labeling information and clinical practice for LAIAs prescribed within the community health system. Patients who are more symptomatic and have additional psychological comorbidities are commonly excluded from clinical trials. Alternative dosing may be clinically necessary to obtain an adequate response, and this may have been captured in this review. This analysis may be hypothesis generating for future studies on LAIAs.

Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa

“…The mean age of the patients in this study was 46 years. This is in keeping with a systematic review that reported a mean age at treatment with LAI – APs ranging from 38.5 years in the 1970s to 39.5 years in the 2000s, 25 a study conducted across six East Asian countries, 18 and similar to three publications from Italy, 35 the United States of America (USA) 36 and Australia. 37 …”

“…The diagnostic indication for a LAI – AP in this study was consistent with several studies that reported that LAI – APs are most frequently prescribed for patients with schizophrenia. 9 , 18 , 27 , 35 , 36 Schizophrenia is a chronic mental illness that is associated with poor adherence to oral medication resulting in a high risk of relapse and admission to hospital. 3 , 38 Adherence to antipsychotic medication is critical for the recovery and restoration of occupational and social dysfunction in schizophrenia.…”

“… 52 The choice of prescription between the two LAI – APs in this study was therefore most probably because of a local prescribing habit, general availability and familiarity with the drug. 36 In the public sector of SA, only FGA LAI – APs are available on the national formulary. 40 Second-generation antipsychotic LAI – APs are obtainable on a named patient basis, by prior motivation through a buy-out process.…”

“…Globally, there is minimal information regarding prescription patterns of LAI – APs in community health settings. 36 Therefore, the strengths of the study are the community clinic setting and the information on real-world patients in usual care, given the general lack of data on antipsychotic utilisation in clinical practice from Africa. 57 Furthermore, this study provides some information on the prevalence of combining LAI –APs and oral psychotropic treatment, which is not well established in low-income and middle-income countries with restricted formularies.…”