The results of a large study are a strong argument for providing long-acting injectable antipsychotics (LAIs) to patients recently diagnosed with schizophrenia.
The researchers found that among patients who switched to LAI, mortality was lower and there were fewer here. suicide attempts compared to patients who continued to take the corresponding oral antipsychotic (OAP).
In addition, switching to an LAI antipsychotic during the first 2 years of OAP reduced the risk of suicide death by 47%.
“With newly diagnosed schizophrenia, more active consideration of ALL at this stage should be encouraged for better long-term outcomes (i.e., risk of mortality and suicide), especially for those who have already exhibited attitudes poor adherence, “said Cheng-yi Huang, MD, told Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan Medscape Medical News.
The study was published online May 11 a JAMA network open.
Powerful incentive to change
Using data from Taiwan’s national health insurance research database, the researchers identified newly diagnosed patients with schizophrenia who received PCOs from 2002 to 2017.
Within this cohort, they defined the LAI group as patients who switched to LAI and were prescribed LAI at least four times in a year. The LAI group adjusted for propensity in patients who continued to receive PCOs from the same compounds. There were 2614 patients in each group (mean age, 30 years).
During the 16-year follow-up period, compared with patients who continued to take OAP, those who switched to LAI had a 34% lower risk of mortality from all causes (adjusted risk ratio). [aHR], 0.66; 95% CI, 0.54 – 0.81), 37% lower mortality due to natural causes (HRH, 0.63; 95% CI, 0.52 – 0.76) and 28% lower risk of suicide attempts (incidence ratio, 0.72; 95% CI, 0.55 – 0.93).
The risk of suicide mortality was 47% lower in patients who switched to LAIs within the first 2 years of starting taking the PLO (HRH, 0.53; 95% CI, 0.30 – 0 , 92).
A recent study of Canada found that the suicide rate among patients with schizophrenia spectrum disorders was more than 20 times higher than in the general population.
“Clinically, most psychiatrists use LAIs with a conservative attitude, and the reasons for this attitude are generally not well supported by current scientific evidence,” Huang and colleagues point out in their article.
Huang said the study provides a powerful incentive to begin treatment with LAI for newly diagnosed patients with schizophrenia.
“Because this study compared the deposit with the same oral compound, as soon as patients show response and tolerability to PAO, they will benefit much more from switching to LAI from the same compound,” Huang said. Medscape Medical News.
Commenting on the study for Medscape Medical News, William Carpenter, Jr., MD, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland, said this report is “very important and in a high quality journal.
“LAIs have been remarkably underused in the United States and have not been considered the main line and initial treatment. This is all an unfortunate attitude, not science,” Carpenter said.
There is now evidence that the field is shifting to LAIs as front-line treatment, “at least conceptually and by research leaders,” he noted.
“In this report, health and suicide information is new, extremely important, and robust. This report should alert physicians to the potential advantage of LAI in suicide prevention,” Carpenter added.
He also comments for Medscape Medical News, Timothy Sullivan, MD, president of psychiatry and behavioral sciences at Staten Island University Hospital in New York City, said the findings provide “another very robust argument for LAIs.
“The decrease in all-cause mortality is really interesting,” Sullivan said, “and it would be interesting to find out if any of this reflects the improvement in metabolic states” with LAIs vs. OAPs.
The finding that people who switched to LAIs within 2 years had a much lower risk of suicide and other types of mortality represents a “powerful argument for change within 2 years,” Sullivan said.
However, in current clinical practice, clinicians often do not suggest ALL until patients have suffered repeated acute episodes of illness after not taking their oral antipsychotics. These episodes have an impact on the individual and their nervous system, Sullivan explained.
“This is really undesirable. We know from other data that the more episodes someone has, the harder it is to control the symptoms of the disease,” he noted.
“We should really think preventively about approaches that will decrease the risk of recurrence, and the evidence in this study is quite compelling that LAI was a significant intervention that reduced the risks. Thinking of LAIs as a preventative measure is a message that has not yet come out in the internship community, “Sullivan added.
The study received support from the Bali Psychiatric Center, Taiwan, through a grant from the Ministry of Health and Welfare. Huang, Carpenter and Sullivan have not revealed any relevant financial relationship.
JAMA Netw Open. Published May 11, 2021. Full text