Long-acting injectable antipsychotics for the treatment of bipolar disorder: evidence from mirror-image studies

Abstract

Clinical trials and real-world data have shown that long-acting injectable antipsychotics (LAIs) might be an effective therapeutic option also for people with bipolar disorder (BD). However, complementing evidence from mirror-image studies investigating LAIs in BD is scattered and has not been systematically evaluated so far. We thus performed a review of observational mirror-image studies testing the effectiveness of LAI treatment on clinical outcomes in people with BD. Embase, MEDLINE, and PsycInfo electronic databases were systematically searched (via Ovid) up to November 2022. We included six mirror-image studies that compared relevant clinical outcomes between the 12-months after (post-treatment period) and the 12-months before (pre-treatment period) the initiation of a LAI treatment in adults with BD. We found that LAI treatment is associated with a significant reduction in days spent in hospital and number of hospitalizations. Moreover, LAI treatment seems to be associated with a significant decrease in the proportion of individuals with at least one hospital admission, even though data on this outcome were reported by just two studies. In addition, studies consistently estimated a significant reduction of hypo-/manic relapses after LAI treatment initiation, while the effect of LAIs for depressive episodes is less clear. Finally, LAI treatment initiation was associated with a lower number of emergency department visits in the year after LAI initiation. The findings of this review seem to suggest that the use of LAIs is an effective strategy to improve major clinical outcomes in people with BD. Nonetheless, additional research, based on standardized assessments of prevalent polarity and relapses, is needed to identify the clinical characteristics of individuals with BD who are most likely to benefit from a LAI treatment.

Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

“…Finally, it should be considered that even the heterogeneity of mental healthcare delivery systems worldwide may influence the probability of access to care for patients with bipolar disorder, especially during depressive episodes. 55 , 56 Indeed, fewer than half of people with bipolar disorder receive mental health treatment, particularly in low-income countries, and only a quarter report contacts with the mental health system. 57 However, those with manic episodes and related behavioural abnormalities may be less likely to avoid detection and treatment.…”

Preliminary data from a 4-year mirror-image and multicentre study of patients initiating paliperidone palmitate 6-monthly long-acting injectable antipsychotic: the Paliperidone 2 per Year study

“…Nonetheless, some patients were carrying a primary diagnosis of personality, bipolar or autism spectrum disorders and intellectual disability. In fact, previous studies have shown that paliperidone LAIs formulations is sometimes used for the maintenance treatment of bipolar disorder 14,15 as well as for the treatment of personality, autistic disorders or mental retardation to help manage aggression, self-harm or impulsivity. 16–19…”

Preventive effect of aripiprazole once monthly on rehospitalization for bipolar disorder: A multicenter 1‐year retrospective mirror image study

“…In addition, 1‐year, retrospective, mirror image studies conducted in Turkey and Italy included a mixed group of patients with bipolar disorder using multiple SGA‐LAIs, such as risperidone LAI, paliperidone LAI, and AOM 20–22 . These studies did not examine the effect of AOM alone on rehospitalization for bipolar disorder by selecting only AOM users 20–23 …”