Long-Acting Injectables Reduce Disease Relapse in Schizophrenia

New evidence suggests long-acting injectable antipsychotics (LAIA) reduce the risk of further hospitalization and suicide ideation for patients with schizophrenia.

A team, led by Yue Wei, MPH, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, compared the risk of disease relapse, health care use, and adverse events linked to the use of LAIAs compared to oral antipsychotics among patients with schizophrenia in Hong Kong.

Limited Data

There is currently only limited evidence on clinical outcomes for long-acting injectable antipsychotics compared to oral antipsychotics in the Asian populations and special patient groups, including those aged older than 65 years, individuals with substance use problems, and early initiators of LAIAs.

In the self-controlled case series study, the investigators examined patients with a schizophrenia diagnosis prescribed LAIAs and oral antipsychotics between 2004-2019 through the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority.

The investigators sought main outcomes of the risk of disease relapse, defined as hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and suicide attempts, health care use, defined as all-cause emergency department visits and hospitalizations, and adverse events, defined as hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms between the time period where patients were treated with LAIAs and oral antipsychotics.

The investigators compared the main outcomes using Poisson regression.

The team identified 70,396 patients with schizophrenia with a mean age of 44.2 years. Of this group, 33.7% (n = 23,719) were prescribed both classes of treatments.

Promising Data

The results show those treated with LAIAs had a lower risk of hospitalization for any cause (n = 20,973; IRR, 0.63; 95% CI, 0.61-0.65), hospitalizations for psychiatric disorders (n = 19,283; IRR, 0.52; 95% CI, 0.50-0.53), hospitalizations for schizophrenia (n = 18,385; IRR, 0.53; 95% CI, 0.51-0.55), and incident suicide attempts (n = 1453; IRR, 0.56; 95% CI, 0.44-0.71) compared to patients treated with oral antipsychotics.

There was also a reduction in hospitalizations for somatic disorders (n = 15,396; IRR, 0.88 95% CI, 0.85-0.91), hospitalizations for cardiovascular diseases (n = 3710; IRR, 0.88; 95% CI, 0.81-0.96), and extrapyramidal symptoms (n = 22,182; IRR, 0.86; 95% CI, 0.82-0.91) during full treatment with LAIAs compared to full treatment with oral antipsychotics.

There were no significant differences found for emergency department visits and similar associations during the subsequent treatment periods beyond 90 days and among older people and individuals with substance use issues, with the exception of an increased risk of extrapyramidal symptoms among older patients with initiating LAIAs in the first 90 days.

Early initiators of LAIAs had a greater reduction in outcome events compared to late initiators.

“This self-controlled case series study of people in Hong Kong with schizophrenia suggests that LAIAs were associated with a lower risk of disease relapse and hospitalization than OAs, without an increased risk of adverse events,” the authors wrote. “Clinicians should more broadly consider the long-term use of LAIAs for Chinese people with schizophrenia, especially early in the course of illness.”

The study, “Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia,” was published online in JAMA Network Open.