In 1952, researchers began using chlorpromazine as an effective treatment for schizophrenia. A few decades later, long-acting versions of antipsychotic treatments, dubbed LAIAs, came on the scene.
In 2003, the FDA approved the first long-acting injection of a second generation antipsychotic (SGA), risperidone. Since then, six additional second generation drugs have also gotten the green light.
Leslie Citrome, MD, MPH, a clinical professor of psychiatry and behavioral sciences at New York Medical College, told Psychiatrist.com that long-acting injectables have advantages for all types of medical conditions.
“Someone with hypertension or diabetes may feel fine. They may feel they don’t need the medicine that day. And so compliance or adherence is actually a problem for those disorders as well,” he said.
Overall Advantages
LAIAs have played a significant role in enabling physicians to treat people with schizophrenia outside of the hospital setting. Clinicians can administer them during an office visit and their effects last for weeks or even months at a time. This helps ensure that patients take their medication as prescribed. Using LAIAs in the maintenance treatment of schizophrenia has also demonstrated a low mortality rate, reduced caregiver burden, and increased patient satisfaction.
One analysis of 25 different studies involving 5,940 patients, for example, found that LAIAs were even better at preventing relapse and hospitalization compared to oral antipsychotics. Participants in these studies first took oral antipsychotics and then switched to LAIAs, and then researchers compared the two responses. Because this treatment course is common in the clinical setting, the researchers said it accurately reflects real-life scenarios and results.
“In general, long-acting injectable antipsychotics, I think are preferred, and for the simple reason is that we no longer have to guess whether someone is taking their medicine or not,” Citrome, who is also the president of the American Society of Clinical Psychopharmacology (ASCP), explained. “So that’s convenient for us, but it’s also convenient for the individual with the illness.”
Currently, LAIAs are typically used to help patients with chronic schizophrenia stick to their treatment plan. But in a 2016 The Journal of Clinical Psychiatry paper, Citrome and his colleagues argued that may also be effective for early-stage symptoms. Studies included in the review found LAIAs superior to placebo for acute and maintenance treatment, supporting their use in early-stage patients. Some studies also pointed to reductions in healthcare utilization and costs with LAIAs.
Overcoming Cons
LAIAs are not without problems. Sometimes, titrating the dose can take longer. There might be some pain at the injection site, and side effects could take more time to go away. And they do require a doctor’s visit which can be a challenge for someone living with schizophrenia. However, Citrome said that many of the newer drugs mitigate these obstacles, especially when it comes to adherence.
“The person has to come back for their injection, but at least we have the opportunity to go and find them and have a discussion regarding the need for medication. For someone who doesn’t show up for their renewal of their oral medicine, it’s often too late,” he said. “At least we have some built in safety time with a long-acting injectable.”
