Lack of Consensus Among Guidelines for LAI Antipsychotics for First-Episode Schizophrenia

injcetion medication
injcetion medication
Researchers conducted a systematic literature review in order to understand how guidelines have changed specifically for the treatment first-episode schizophrenia.

The following article is a part of conference coverage from Psych Congress 2021 , held October 29th through November 1, 2021, in San Antonio, Texas. 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 Psych Congress 2021.


A systematic review found that clinical practice guidelines (CPGs) recommended antipsychotic monotherapy for patients with first-episode schizophrenia and that in general, antipsychotics should be delivered by long-acting injectables (LAIs) as early as the first illness episode. However, only 1 CPG recommended for LAIs to be the delivery method of choice for first-episode schizophrenia. These findings were presented during Psych Congress 2021 held in San Antonio, Texas, from October 29 to November 1, 2021.

Guidelines have recently been updated because there has been evidence that LAI antipsychotic therapies have clinical benefit for patients with schizophrenia, such as decreased risk for relapse, hospitalization, and all-cause discontinuation. Researchers from Janssen Scientific Affairs conducted a systematic literature review through December 2019 in order to understand how guidelines have changed specifically for the treatment of first-episode schizophrenia.

A total of 19 CPGs were included in this review sourced from the United States (n=7), United Kingdom (n=3), Australia and New Zealand (n=1), Canada (n=1), France (n=1), Italy (n=1), Poland (n=1), and Singapore (n=1).

There was an overall lack of consensus about what antipsychotic monotherapy should be preferred for patients with first-episode schizophrenia. Most CPGs instructed physicians to use a trial-and-error method, in which the patient is prescribed 1 antipsychotic and, in the event of failure or intolerance, switched to another.

A total of 5 CPGs recommended for LAIs to be an option for patients with first-episode schizophrenia and only the CPG from Florida Medicaid recommended for LAIs to be the first-step equivalent to oral antipsychotics.

Most CPGs advocated for lower dosages to be given to patients experiencing a first episode than should be administered to patients with chronic illness.

There was also a lack of consensus for duration of antipsychotic use among this patient population, ranging from 6 to 12 months to at least 2 years.

The study authors concluded that despite a shift in CPGs to recommend LAIs as early as first illness episode, the specific guidelines for first-episode schizophrenia did not reflect this shift, with only 1 CPG recommending for patients with schizophrenia to be given LAI before other oral equivalents.

Disclosure: This research was sponsored by Janssen Scientific Affairs. Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


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Correll CU, Martin A, Patel C, Benson C, Goudling R, Kern-Sliwa J. A systematic literature review of schizophrenia clinical practice guidelines: recommendations on antipsychotic treatment of first-episode schizophrenia. Poster presented at: Psych Congress 2021, October 29-November 1, 2021; San Antonio, Texas. Poster 146.