The case is building for the benefits of long-acting injectables (LAIs) in early-diagnosis schizophrenia.
A Case For LAIs
One study out of Taiwan last year found that switching to LAIs during the first three years of treatment improved antipsychotic adherence, decreased relapses, and reduced long-term mortality. Over a period of 13 years, 312 patients who received LAIs initially had a lower risk of dying from any cause compared to those who initially received oral medication. They were also less likely to be rehospitalized, admitted to a psychiatric hospital, or visit the psychiatric emergency room.
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Yet LAIs still remain underutilized, especially early in the treatment of schizophrenia. In a recent The Journal of Clinical Psychiatry study, a dataset of commercially insured patients put the use of LAI in the early-phase of the disease somewhere around 4 percent. Even when LAIs were given to these patients, they were generally not the first therapy. Most patients still tried several oral treatments first.
“In my opinion, we should use LAIs whenever possible,” said Jose Rubio, MD, one of the authors of the study who is also an assistant professor at Feinstein Institutes for Medical Research. “There are very few circumstances under which you would prefer to use an oral.”
Rubio said that patients at the beginning of their diagnosis stand to gain the most from LAI formulations. Statistically, these patients are the most likely to interrupt treatment. And they are more inclined to show a better response to the initial implementation of an LAI. Early treatment also aligns with recently revised treatment guidelines, which are increasingly supportive of the use of LAIs among younger individuals with early-phase schizophrenia.
One of the big advantages of LAIs over oral medications is convenience, Rubio pointed out.
“People who live with schizophrenia may have some additional challenges. They may have some symptoms that interfere with the ability to take medications on a daily basis,” he said.
Up For Debate
This is not to say that LAIs are always a perfect solution. The multinational EULAST study, conducted at more than 50 hospitals, found no substantial adherence advantage for LAIs over oral treatment. They didn’t improve time to discontinuation in patients with early-phase schizophrenia. If the goal is to prevent a patient from stopping their antipsychotic medication in daily clinical practice, the researchers said they could find no edge in favor of LAIs.
Rubio’s own results found that a mere 11 percent of patients stayed on an LAI medication continuously for at least 90 days. Perhaps therapy didn’t work well for them or they couldn’t tolerate the side effects, he concluded.
But Rubio stressed that there is growing evidence indicating how effective LAI treatment can be. They can be especially helpful during the initial phase of schizophrenia, he said. He advised considering them for first-line treatment in schizophrenia with an eye towards preventing relapse.
“I think that the industry is realizing how useful these drugs are and the data are very robust. They demonstrate that they are better in a number of outcomes compared with their oral counterparts.” he said. “So we realize that these are very powerful formulations and that it’s important to have access to more drugs that come as long-acting,” he said.
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