Long‐acting injectable antipsychotics in early psychosis: a literature review

Emsley, Robin; Chiliza, Bonginkosi; Asmal, Laila; Mashile, M.; Fusar‐Poli, Paolo

doi:10.1111/eip.12027

Cited by 52 publications

(55 citation statements)

References 49 publications

(83 reference statements)

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“…This is important as dysregulation of the normal myelination trajectory may contribute to the functional deterioration and treatment resistance observed in chronic schizophrenia [139]. The clinical imperative to reduce relapse rates stems also from the added economic burden of treating relapse, possibly leading to unavoidable hospital admissions [134,[141][142][143][144][145][146][147]. Finally, relapses due to medication non-adherence can have devastating social consequences themselves.…”

Section: Results Of Descriptivementioning

confidence: 99%

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

et al. 2015

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With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.

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Section: Results Of Descriptivementioning

confidence: 99%

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

et al. 2015

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“…However, this practice is not evidence based and there are anecdotal reports that LAIs may be of particular value when used early in the course of illness 16, 23, 26, 27, 28, 29, 30. Recently, a few randomized studies have demonstrated the value of using APs early in the course of schizophrenia 31, 32.…”

Section: Discussionmentioning

confidence: 99%

Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement

Alphs

Bossie

Mao

et al. 2015

Early Intervention Psych

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AimLong‐acting injectable antipsychotics (APs) are not well studied in recent‐onset schizophrenia. This exploratory analysis of a study designed to reflect real‐world schizophrenia, as defined by patients, interventions and outcomes, compared relative treatment effect between once‐monthly paliperidone palmitate (PP) and daily oral APs in patients with recent‐onset or chronic illnessMethodsThis randomized, open‐label, event monitoring board–blinded study compared treatment response in subjects with schizophrenia and a history of criminal justice system involvement following treatment with PP or oral APs for 15 months (ClinicalTrials.gov identifier, NCT01157351). Event‐free probabilities were estimated using Kaplan–Meier method; hazard ratios (HRs) were estimated using Cox proportional hazard models. This subgroup analysis analysed data by disease duration (≤5 (recent‐onset) or >5 years (chronic illness) since first psychiatric diagnosis).ResultsSeventy‐seven subjects met the criteria for recent‐onset illness; 365 for chronic illness. HRs (95% CI) for treatment failure for oral APs versus PP were 1.73 (0.87–3.45; P = 0.121) for recent‐onset and 1.37 (1.02–1.85; P = 0.039) for chronic illness. Most common adverse events for PP versus oral APs were injection site pain (recent‐onset, 26% vs. 0%; chronic, 17% vs. 0%), increased weight (14% vs. 6%; 12% vs. 6%), akathisia (14% vs. 9%; 10% vs. 7%), insomnia (12% vs. 17%; 18% vs. 10%) and anxiety (12% vs. 6%; 10% vs. 8%).ConclusionsAlthough neither pre‐planned nor adequately powered, the estimated HRs suggest that the relative advantage of PP over oral APs for reducing the risk for treatment failure may be greater in patients with recent‐onset schizophrenia than in those with more chronic illness.

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“…In fact, given the importance of continuous treatment in the early phases of schizophrenia, LAI APs may also be a treatment option [Kim et al 2012;Emsley et al 2013], and in the context of a shared decision-making approach Kirschner et al 2013], it could reduce the negative image and stigmatization attached to depots [Kirschner et al 2013].…”

Section: Guidelines and Recommendations For The Treatment Of Schizophmentioning

confidence: 99%

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

Brissos¹,

Ruiz‐Veguilla

Taylor

et al. 2014

Therapeutic Advances in Psychopharmacology

232

200

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Historical background of long-acting injectable antipsychotics Soon after the introduction of antipsychotics (APs) in the 1950s, poor adherence to oral formulations was found to be a critical issue. This led to the development in 1966 of the first long-acting injectable (LAI) AP fluphenazine enanthate, and fluphenazine decanoate some 18 months later, to reduce the incidence of side effects of the former [Johnson, 2009]. Haloperidol decanoate became available in Europe in 1981 and in the USA in 1986 [Knudsen, 1985]. Clinical trial results showed a dramatic reduction in the morbidity of schizophrenia [Gottfries and Green, 1974; Johnson, 2009]. However, the concept of LAIs for schizophrenia was not initially received warmly by the medical profession for fears of increased side effects, lack of efficacy, and the fact this was seen as an attempt by psychiatrists to impose a treatment upon patients without due regard to their feelings or rights [Johnson, 2009] as well as the potential for medicolegal problems [Glazer and Kane, 1992]. However, with subsequent surveys and trials suggesting their benefits [Rifkin et al. 1977; Schooler et al. 1980; Hogarty et al. 1979], LAIs became more widely adopted. The introduction of the oral second-generation APs (SGAs) brought claims of better tolerance and less severe side effects, even though their use may be hindered by metabolic syndrome [Meyer and Stahl, 2009]. They also have potential to prevent or reverse accelerated frontotemporal cortical grey matter decline, and to provide a greater degree of neuroprotection than first generation APs (FGAs) [Keefe et al. 2004; Robinson et al. 2006]. The introduction of SGAs led to a decline in the use of LAI FGAs [Patel et al. 2003; Patel and David, 2005]. However, it soon became clear that atypical characteristics did not bring better adherence rates with oral SGAs. The recent introduction of LAI SGAs allows psychiatrists once

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Long‐acting injectable antipsychotics in early psychosis: a literature review

Cited by 52 publications

References 49 publications

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 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

Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement

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

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