Impact of atypical long-acting injectable versus oral antipsychotics on rehospitalization rates and emergency room visits among relapsed schizophrenia patients: a retrospective database analysis

Abstract

BackgroundAmong schizophrenia patients relapsed on an oral antipsychotic (AP), this study compared the impact of switching to atypical AP long-acting injectable therapy (LAT) versus continuing oral APs on hospitalization and emergency room (ER) visit recurrence.MethodsElectronic records from the Premier Hospital Database (2006-2010) were analyzed. Adult patients receiving oral APs during a schizophrenia-related hospitalization were identified and, upon relapse (i.e., rehospitalization for schizophrenia), were stratified into (a) patients switching to atypical LAT and (b) patients continuing with oral APs. Atypical LAT relapse patients were matched 1:3 with oral AP relapse patients, using a propensity score model. Andersen-Gill Cox proportional hazards models assessed the impact of atypical LAT versus oral AP on time to multiple recurrences of all-cause hospitalizations and ER visits. No adjustment was made for multiplicity.ResultsAtypical LAT (N = 1032) and oral AP (N = 2796) patients were matched and well-balanced with respect to demographic (mean age: 42.1 vs 42.4 years, p = .5622; gender: 43.6% vs 44.6% female, p = .5345), clinical, and hospital characteristics. Over a mean 30-month follow-up period, atypical LATs were associated with significantly lower mean number of rehospitalizations (1.25 vs 1.61, p < .0001) and ER visits (2.33 vs 2.67, p = .0158) compared with oral APs, as well as fewer days in hospital (mean days: 13.46 vs. 15.69, p = .0081). Rehospitalization (HR 0.81, 95% CI 0.76–0.87, p < .0001) and ER visit (HR 0.88, 95% CI 0.87–0.93, p < .0001) rates were significantly lower for patients receiving atypical LAT versus oral APs.ConclusionsThis hospital database analysis found that in relapsed schizophrenia patients, atypical LATs were associated with lower rehospitalization and ER visit rates than oral APs.

The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal

“…In contrast, two prospective studies comparing LAI FGAs with various oral SGAs found the oral SGAs to be associated with lower risk of readmission and higher odds ratio of achieving remission compared with LAIs [Conley et al 2003;Haro et al 2006Haro et al , 2007. In the same vein, the electronic records of patients medicated with LAI SGAs were compared with oral APs over a 30-month period revealed that LAI SGAs were associated with significantly lower mean number of rehospitalizations, emergency room visits and fewer hospitalization days compared with oral APs [Lafeuille et al 2013].…”

Effectiveness of Oral Antipsychotic versus Long-Acting-Injectable Antipsychotics: A Comparison of Suicidality, Relapse, and Recidivism

“…We believe these are reasonable indicators of patient relapse as the psychiatric disorders included in the study are often linked to extreme symptoms and behaviours including: psychosis, suicidal ideation, violence, drug abuse and others, all of which warrant medical attention (Lafeuille et al, 2013;Chapman et al, 2015;Hogarty and Ulrich, 1998). Repeated relapses in patients has been shown to increase the risk for shorter remission periods and higher severity of future episodes (Su et al, 2009;Sheperd et al, 1989).…”

“…Previous studies have exhibited a reduction in healthcare resource utilization in schizophrenic patients treated with LAI medication (Lafeuille et al, 2013;Koczerginski & Arshoff, 2011;Su et al, 2009;Davis, 1975;Sena et al, 2003;Olivares et al, 2009;Sheperd et al, 1989). At Lakeridge Health Oshawa (LHO), a midsized community hospital in Oshawa, Ontario, Canada, a group of patients with disorders associated with psychosis were switched from OA treatment to LAI regimens, and multiple drug types were included.…”

“…Many antipsychotic medications have been made available in a longacting-injectable (LAI) formulation, in which patients are required to receive an appropriate dosage on a specific recurring timeinterval (Lafeuille et al, 2013). Medical professionals are then able to assume greater confidence that their patients are adhering to their treatment plans -if they regularly attend appointments scheduled for injection.…”

“…Patients who suffer from psychiatric disorders associated with psychosis relapse despite treatment with antipsychotic medication (Lafeuille et al, 2013), leading to re-hospitalization (emergency room (ER) visits, and admissions), high healthcare costs, and other poor outcomes (Koczerginski & Arshoff, 2011;Su et al, with therapy, such as hallucinations, poor cognition, lack of insight, social stigma and other factors; furthermore, many patients need assistance to take the medication (Haddad et al, 2014). Many antipsychotic medications have been made available in a longacting-injectable (LAI) formulation, in which patients are required to receive an appropriate dosage on a specific recurring timeinterval (Lafeuille et al, 2013).…”