RESEARCH WEEKLY: Importance of Long-Acting Injectable Antipsychotics in Early Stage Schizophrenia
By Elizabeth Hancq
Preventing a subsequent psychotic episode and resulting hospitalization in people in early phase schizophrenia is a key public health problem with substantial consequences to the individual suffering. Previous research has shown that second episodes of psychosis in the same individual respond less well to the same treatment. Meanwhile, longer durations of untreated psychosis lead to a host of consequences, such as physical brain damage and cognitive challenges.
Preventing psychotic episodes in individuals with schizophrenia with proper medications and therapies is crucial for their prospects toward longer-term recovery. However, adherence to antipsychotic medication is low. Previous research has shown that after an individual’s first hospitalization for schizophrenia, 1/3 of patients discontinue their antipsychotic medications within 30 days of discharge, while more than half of patients have discontinued their medications after 60 days.
Results from a randomized clinical trial published earlier this month in JAMA Psychiatry suggest that long-acting injectable antipsychotic medications can prevent relapse and re-hospitalization in patients with early phase schizophrenia. The results of the study provide further evidence to support the more widespread use of long-acting formulations in individuals with severe mental illness.
The first US-based randomized clinical trial on long-acting injectable medications
The Prevention of Relapse in Schizophrenia (RELAPSE) study is a multicenter, clustered randomized control trial that allows investigators to randomize the treatment options provided to participants without affecting their overall care. A total of 489 individuals with schizophrenia participated in the study, all of whom were in their early stage of the illness (fewer than five years of antipsychotic use). Approximately half of patients received the long-acting formulation of the antipsychotic aripiprazole, whereas the other half received care as usual.
Using long-acting injectable antipsychotic medication in individuals with early stage schizophrenia reduced the risk of re-hospitalization by almost half (44%), according to the results. The total number of hospitalizations among individuals taking the long-acting injectable antipsychotic medication decreased by 36%, however this finding was not statistically significant. The study authors included all psychiatric hospitalizations in their analysis, not just those related to symptoms of psychosis, which may have decreased the statistical power of the study.
Barriers to usage of long-acting injectable medications
Long-acting injectable antipsychotic medications are extremely underutilized by prescribers and patients. Additionally, the United States has much lower prescribing of these medications for individuals with serious mental illness compared to other developed countries. Long-acting formulations of antipsychotic medications are especially infrequently used for individuals in the early stages of their illness, despite their benefits in increasing medication adherence.
“Many attribute the low rate of LAI [long-acting injectable medication] use in clinical practice to patient refusal. However, PRELAPSE demonstrates that, with proper training, practitioners are able to communicate potential advantages of LAIs, even in early illness stages, and engage patients in shared decision-making resulting in high acceptance rates,” the study authors write.
The authors acknowledge that provider training on long-acting injectable medication was a major part of the study design, however the results should be generalizable to any community mental health practice. More work is needed to improve access to these evidence-based treatment practices to ensure people with severe mental illness achieve their best outcomes.
