High Rate of Discontinuation during Long-Acting Injectable Antipsychotic Treatment in Patients with Psychotic Disorders

Abstract

Treatment discontinuation is a major challenge in routine clinical settings. Despite poor adherence to antipsychotic medication, long acting injectable (LAI) formulations are an underutilized option in psychotic disorders. Recently, an earlier and broader use of LAIs has been emphasized. However, few studies have evaluated the factors associated with LAI antipsychotic discontinuation in ordinary clinical practice. The main purpose of the present study was, therefore, to identify the factors associated with LAI discontinuation in a real-world setting. Patients in treatment with LAI antipsychotics were recruited. A Cox regression analysis was applied considering a 12-month follow-up period. Moreover, a Kaplan-Meier survival analysis was applied to compare the single treatment LAI antipsychotic groups in terms of time to discontinuation. Our analysis showed an LAI discontinuation rate at 12 months, corresponding to 28.8%, with olanzapine and aripiprazole having a longer time to discontinuation compared to zuclopenthixol. The results of the present study can help clinicians with their choice of LAI antipsychotic according to patients’ characteristics and in a context of precision medicine. Increasing knowledge about factors affecting discontinuation of LAI antipsychotics can improve the prescribing practices of these compounds. Individualized approaches may ameliorate long-term patients’ treatment adherence, thus preventing the long-term disability caused by psychotic disorders.

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

“…In contrast with international clinical guidelines supporting an early and broad use of LAI antipsychotics (Llorca et al ., 2013), our findings paint the picture of a use of these compounds in chronic patients. Of note, a relevant part of our sample met the features tipically reported in other studies: subjects with low educational level and income, poor social support and a chronic course of illness, as showed by repeated hospitalizations, multiple incarcerations and previous management in community mental health services (Ostuzzi et al ., 2018; Bhatta et al ., 2021; Auxilia et al ., 2023).…”

“…In the context of these considerations, some pragmatic aspects can be listed to explain the large use of FGA-LAIs in our sample. First of all, FGA-LAIs are still frequently prescribed in the light of their low cost and long clinical experience despite the troublesome side effects such as the motor symptoms (Kane et al ., 2021; Auxilia et al ., 2023). Second, FGA-LAIs might be useful in some patients with prominent aggressive behavior that frequently characterizes subjects hosted in detention centers (Mohr et al ., 2017; Barbui et al ., 2020).…”

“…The multivariate regression model comparing SGA and FGA-LAIs showed that SGA-LAIs were significantly more often prescribed among individuals with a diagnosis of bipolar disorder and taking antidepressants. This is not surprising as these compounds act more on affective symptoms than FGAs and they are considered to be effective for preventing re-exacerbations of bipolar disorder (Ostuzzi et al ., 2018; Barbui et al ., 2020; Auxilia et al ., 2023). Nevertheless, beyond their stated role in the treatment of schizophrenia, some SGA-LAIs including risperidone and aripiprazole, were approved by the US Food and Drug Administration for the maintenance treatment in bipolar disorder whilst, until now, no LAI has been recommended by the EMA (Keramatian et al ., 2019).…”

“…In addition, at least three considerations can be expressed. First, in line with our findings, haloperidol represents the most frequently administered compound in some community based-studies (Carr et al ., 2016; Grover et al ., 2019; Auxilia et al ., 2023). Nevertheless, it should be noted that available literature shows contrasting data about the preferential prescribed compound among LAI antipsychotic medications (Reymann et al ., 2022), in the light of different study methods and local factors (Barbui et al ., 2020).…”

“…Several studies demonstrated the efficacy of LAI compounds since the first episode of illness, because these formulations can ensure a prolonged remission, functional recovery and reduced risk of disorder progression (Correll et al ., 2016; Tiihonen et al ., 2017). Data in the literature agree that treatment adherence is one of the most important factors in reducing direct and indirect healthcare costs for patients affected by severe mental conditions (García-Carmona et al ., 2021; Auxilia et al ., 2023), although the use of these formulations for bipolar and personality disorders has not yet been approved by European Medical Agency (EMA) (Pacchiarotti et al ., 2019; Salvi et al ., 2019).…”