Long-Acting Injectable Antipsychotics for First-Episode Schizophrenia: The Pros and Cons

Abstract

Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent “at any stage.” Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.

Recommendations for the optimal care of patients with recent‐onset psychosis in the Asia‐Pacific region

“…Despite their potential advantages, most treatment guidelines advise limiting the use of LAI APs to multiple‐episode or non‐adherent patients, with controversy in relation to their role in early schizophrenia (Kim et al ., ); however, recommendations for LAI AP use early in the disease course are emerging, not least during the first two to five years following diagnosis (Malla et al ., ) and as maintenance treatment following the initial episode (Llorca et al ., ). Using LAI APs as the initial therapeutic treatment can reduce relapse rates and improve prognosis (Viala et al ., ), and many first‐episode patients taking oral antipsychotics will accept a recommendation of the corresponding LAI therapy (Weiden et al ., ).…”

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

“…The development of LAAPs has provided a potentially better option than oral antipsychotics in the management of treatment discontinuity [11,[148][149][150][151]. With LAAPs, medication delivery, and thus treatment continuity, is at least clearly observable for the healthcare professional.…”

Clinical benefits and impact of early use of long‐acting injectable antipsychotics for schizophrenia

“…20,21 Although LAIs traditionally have been reserved for patients at later periods of their disease, increasingly, LAI use is being advocated for early episodes of schizophrenia including after first hospitalization to achieve optimal outcomes such as reduced rates of recurrence, rehospitalization, and comorbidities and complications of untreated/ undertreated illness. 22,23 An important question is whether LAIs have beneficial effects on the clinical course, medical resource use and costs of therapy when used early for treatment or for treatment of first-episode of schizophrenia. Newer literature has centred on a single-minded focus of collaborating with the person with schizophrenia, suggesting that the individual and practitioner develop a strategy for shared decision-making related to treatment, including but not limited to which medications best suit the individual's needs 24 and when those medications should be utilized.…”