Recommendations for Long-Acting Injectable Antipsychotics in Schizophrenia

Clozapine Better for Comorbid Schizophrenia, Cannabis Use Disorder
Clozapine Better for Comorbid Schizophrenia, Cannabis Use Disorder
Several clinical practice guidelines on the treatment of schizophrenia have recently been updated in the United States. In order to understand the recommendations of current clinical practice guidelines, the study authors conducted a systematic literature review.

The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.


Based on US guidelines for the treatment of schizophrenia, long-acting injectable antipsychotics (LAIs) can improve adherence to other therapies and may be an option for first-episode schizophrenia, according to study results presented at the American Psychiatric Association annual meeting, held virtually from May 1 to May 3, 2021.

The study investigators performed a systematic review of clinical practice guidelines focused on the use of LAIs to manage schizophrenia published in the US between 2004 and 2019. The findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the quality and reporting of clinical practice guidelines were assessed using the AGREE II tool.

Investigators identified 7 clinical practice guidelines on the treatment of schizophrenia, including the American Association of Community Psychiatrists, American Psychiatric Association, Schizophrenia Patient Outcomes Research Team, and state-level guidelines from Florida, New Jersey, Oregon, and Texas. All guidelines reported recommendations on the use of LAIs to varying degrees of agreement.

Florida, New Jersey, and Texas guidelines recommended LAIs for patients with first-episode schizophrenia, although the Schizophrenia Patient Outcomes Research Team stated they were not appropriate for treating first-episode schizophrenia. All but the American Psychiatric Association recommended the use of LAIs in maintenance therapy and primarily in the case of nonadherence to an oral antipsychotic regimen. Most guidelines agreed that the prescription of LAIs should be based on patient preference, but only the Florida guidelines recommended LAIs as a first-line equivalent to oral antipsychotics.

All 4 state-level guidelines incorporated treatment algorithms to support their LAI recommendations; however, the 3 national guidelines did not. Because algorithms facilitate the implementation of treatment recommendations, they should be included in all future clinical practice guidelines to clarify the role of LAIs in the treatment paradigm for schizophrenia, according to researchers.

The study investigators concluded that prescription of LAIs may improve adherence to other therapies and should be based on patient preference. Although some guidelines clashed on the recommendation of LAIs for first-episode schizophrenia, only state-level guidelines reported clinical algorithms in support of their recommendation.

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Benson C, Correll C, Martin A, Goulding R, Kim E. Systematic review of schizophrenia clinical practice guidelines: Recommendations on use of long-acting injectable antipsychotics in the United States. Presented at: APA 2021 annual meeting May 1-3, 2021. Abstract/Poster 5390.