Long-Acting Injectable Antipsychotics Delay Schizophrenia Relapse

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The risk for relapse was 52% lower for patients withdrawing from paliperidone injection every 3 months compared with the monthly injection.
The risk for relapse was 52% lower for patients withdrawing from paliperidone injection every 3 months compared with the monthly injection.

According to the results of a recent study published in the Journal of Clinical Psychiatry, long-acting injectable formulations of paliperidone palmitate delay relapse significantly after withdrawal compared with oral paliperidone among patients with schizophrenia.

In a post hoc analysis of 3 randomized controlled trials, the time to relapse after treatment withdrawal among 449 adults with schizophrenia was evaluated for extended-release oral paliperidone (n = 101), once-monthly paliperidone palmitate injection (n = 203), and once-every-3-months paliperidone palmitate injection (n = 145).

Median time to relapse after withdrawal of medication was 58 days for oral paliperidone (95% CI, 42-114 days), 172 days for monthly paliperidone injection (95% CI, 134-222 days), and 395 days for once-every-3-months paliperidone injection (95% CI, 274 days to not reached; P <.001 for pair-wise comparisons).

The researchers found that relapse risk was 56% and 79% lower for patients who withdrew from monthly or once-every-3-month injectable formulations compared with oral paliperidone, respectively (P <.001 for both). Moreover, the risk for relapse was 52% lower for patients withdrawing from paliperidone injection every 3 months compared with the monthly injection (P <.001).

The study authors concluded that the study results "may be relevant for risk mitigation strategies in schizophrenia, a condition in which interruptions in maintenance antipsychotic treatment are commonplace and unpredictable."

Reference

Weiden PJ, Kim E, Bermak J, Turkoz I, Gopal S, Berwaerts J. http:Does half-life matter after antipsychotic discontinuation? A relapse comparison in schizophrenia with 3 different formulations of paliperidone. J Clin Psychiatry. 2017;78(7):e813-e820.

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