Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia

Abstract

Schizophrenia is a debilitating chronic disease that requires lifelong medical care and supervision. Even with treatment, the majority of patients relapse within 5 years, and suicide may occur in up to 10% of patients. Poor adherence to oral antipsychotics is the most common cause of relapse. The discontinuation rate for oral antipsychotics in schizophrenia ranges from 26% to 44%, and as many as two-thirds of patients are at least partially nonadherent, resulting in increased risk of hospitalization. A very helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics, although only a minority of patients receive these. Reasons for underutilization may include negative attitudes, perceptions, and beliefs of both patients and health care professionals. Research shows, however, significant improvements in adherence with LAIs compared with oral drugs, and this is accompanied by lower rates of discontinuation, relapse, and hospitalization. In addition, LAIs are associated with better functioning, quality of life, and patient satisfaction. A need exists to encourage broader LAI use, especially among patients with a history of nonadherence with oral antipsychotics. This paper reviews the impact of nonadherence with antipsychotic drug therapy overall, as well as specific outcomes of the schizophrenia patient, and highlights the potential benefits of LAIs.

The effects of switching from oral to LAI antipsychotic treatment on subjective experience of schizophrenic and schizoaffective patients: Preliminary results

“…Th ese preliminary results are consistent with previous reports indicating the switch from oral to LAI antipsychotic treatment as a safe and eff ective intervention in clinically stable schizophrenic and schizoaff ective patients (Ju et al 2014;Kaplan et al 2013;Lafeuille et al 2013;Rauch and Fleischhacker 2013). Th is seems to be further confi rmed by the almost-complete patients ' adherence to our protocol and by the lack of adjustments of concomitant treatments found in our study.…”

“…Similarly, while the benefi ts of second-generation over fi rst-generation antipsychotics (SGA vs FGA) (Crossley et al 2010;Leucht et al 2013) and of long-acting injectable over oral (LAI vs oral) antipsychotic formulations (Ju et al 2014;Kaplan et al 2013;Lafeuille et al 2013;Rauch and Fleischhacker 2013) in terms of better effi cacy, prevention of relapse, tolerability, and drug kinetics and dynamics have been widely demonstrated, less research have been devoted to the evaluation of the subjective impact of switching antipsychotic administration from oral to LAI (Iyer et al 2013;Kaplan et al 2013;Kirschner et al 2013;Rosa et al 2012).…”

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

“…Current guidelines and recommendations on schizophrenia consider LAAPs as drugs of choice for the treatment of schizophrenia patients with recurrent relapses related to non-adherence with antipsychotic medication [11,65,[152][153][154][155][156]. Recent reviews have never been more vocal about their use in early-episode patients for similar reasons (provided schizophrenia has been diagnosed or clinically highly suspected), as these patients ''have more to lose'' [134,[157][158][159][160][161][162][163][164][165][166][167][168][169][170]. LAAPs may, if presented correctly, be more effective for maintaining medication continuity, preventing relapse, reducing the number and duration of rehospitalizations and, when achieving remission, holding this status [161,166,168,169,[171][172][173][174][175].…”

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

“…In fact, studies of patients initiated or switched from oral to LAI APs reported significant improvements not only in schizophrenia symptom control, but also in quality of life, satisfaction and functioning [Kaplan et al 2013].…”