Long-Acting Injectables Effective in Patients With Comorbid Psychosis, Substance Use Disorder

Long-acting injectable (LAI) aripiprazole and paliperidone were both associated with reduced substance cravings and improved quality of life in patients with comorbid psychosis and substance use disorder, according to data published in Neuropsychiatric Disease and Treatment.

Inpatients with comorbid psychosis and substance use disorder were randomly assigned to 400 mg intramuscular aripiprazole monohydrate once-monthly (n=50) or 100 mg intramuscular paliperidone palmitate once-monthly (n=51). The Clinical Global Impression Scale-Severity was used to capture clinical symptoms at baseline and at the 1-year end point. Substance craving intensity and quality of life were measured at each time point using a visual analog scale and the World Health Organization scale, respectively. 

Aripiprazole and paliperidone were each associated with significantly improved Clinical Global Impression Scale scores from baseline to follow-up (both P <.00001). In addition, both LAIs showed a reduction in substance craving over the 1-year study period, although the improvement was more significant in the aripiprazole group (P =.019). Aripiprazole improved quality of life in all domains with large or very large effect sizes, including the physical, psychological, social relationships, and environment domains (all P <.00001). Paliperidone was also associated with improved quality of life in each domain, although effect sizes for the physical (P <.002) and psychological (P <.01) domains were smaller than those in the aripiprazole group.  

Patients treated with aripiprazole were found to be younger than patients treated with paliperidone (P =.001), although no other significant sociodemographic differences were identified. There was a higher percentage of patients with schizophrenia spectrum disorders in the paliperidone group (P =.003).

Although both LAIs were associated with improvements in quality of life, symptomatology, and substance craving, the aripiprazole group showed more significant progress for each measure. As psychosis and substance use disorder comorbidity can make oral medication adherence difficult, LAIs may be an effective therapeutic alternative in patients in this demographic.

Reference

Cuomo I, Kotzalidis GD, de Persis S, et al. Head-to-head comparison of 1-year aripiprazole long-acting injectable (LAI) versus paliperidone LAI in comorbid psychosis and substance use disorder: impact on clinical status, substance craving, and quality of life. Neuropsychiatr Dis Treat. 2018;14:1645-1656.