Second Generation Long-Acting Injectable Drugs Effective for Schizophrenia

Second generation long-acting injectable antipsychotic drugs are associated with a reduced number of adverse outcomes for treating patients newly diagnosed with schizophrenia, according to a study published in Schizophrenia Research.

This population-based, retrospective study sought to investigate the associations of second generation long-acting injectable antipsychotic drugs in patients with schizophrenia with specific patient outcomes, including number of relapses, psychiatric admissions, hospitalizations, self-harm, and costs related to healthcare services.

Data was retrieved from the Danish Psychiatric Central Research Register and included a cohort of 10,509 incident patients diagnosed with schizophrenia who initiated long-acting injectable antipsychotics: 2223 patients were analyzed in a 6-month period, 1383 in a 12-month period, and 713 in a 24-month period. Outcome measures defined relapse as number of hospitalization events, number of admissions to a psychiatric ward, and number of bed days related to hospitalization in a psychiatric ward. Hospital costs, self-harm, severity of primary psychiatric disorder, and comorbidities were secondary outcomes.

The number of relapses patients experienced after initiating long-acting injectable antipsychotics was reduced 35% to 40% with an incidence rate ratio of 0.60 for the first 6 months, 0.64 for the first 12 months, and 0.64 for the first 24 months. The number of psychiatric admissions was similarly reduced, with incidence rate ratios of 0.59, 0.60, and 0.64 for the respective periods. The study reported an 85% reduction in psychiatric bed days, and consequently, associated hospitalization costs decreased. Lower risk of relapse was associated with a higher age at diagnosis as well as a later calendar year of diagnosis, suggesting the use of long-acting injectable antipsychotic drugs as an early treatment option for schizophrenia.

A limitation of the study was expectation bias following the initiation of long-acting injectable antipsychotics; for one, initiation is not a random event, and treatment is typically initiated due to relapse or low adherence to previous treatments.

Even though causality was not inferred through the study design, the findings support second generation long-acting injectable antipsychotic drug use as early treatment option to increase treatment adherence and to decrease the risk of relapse, hospitalization, and deteriorating social functions.

Disclosures: RE Nielsen has received research grants from H. Lundbeck and Otsuka Pharmaceuticals for clinical trials, received speaking fees from Bristol-Myers Squibb, Astra Zeneca, Janssen & Cilag, Lundbeck, Servier, Otsuka Pharmaceuticals, and Eli Lilly and has acted as advisor to Astra Zeneca, Eli Lilly, Lundbeck, Otsuka Pharmaceuticals, Takeda, and Medivir. KB Hessellund has no interests to declare. JB Valentin has no interests to declare. RW Licht has received research grant from Glaxo Smith Kline, honoraria for lecturing from Pfizer, Glaxo Smith Kline, Eli Lilly, Astra-Zeneca, Bristol-Myers Squibb, Janssen Cilag, Lundbeck, Otsuka, Servier and honoraria from advisory board activity from Glaxo Smith Kline, Eli Lilly, Astra-Zeneca, Bristol-Myers Squibb, Janssen Cilag, and Sunovion.

Reference

Nielsen RE, Hessellund KB, Valentin JB, Licht RW. Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia [published online July 10, 2018]. Schizophrenia Res. doi:10.1016/j.schres.2018.07.020