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Long-acting injectable antipsychotics lead to better outcomes than oral antipsychotics

Long-acting injectable risperidone led to better medication adherence, greater relapse prevention and better psychotic symptom control than oral antipsychotics among patients with recent onset of schizophrenia.

“An earlier study found that nonadherence with oral risperidone strongly predicted the return of psychotic symptoms in patients with a first episode of schizophrenia. Oral antipsychotic medication requires daily recommitment to treatment, which is hampered by patients’ poor awareness of the need for continued treatment. Long-acting injectable antipsychotic medication has the potential to control psychotic symptoms substantially better than short-acting medication,” study researcher Kenneth L. Subotnik, PhD, of the University of California, Los Angeles, and colleagues wrote in JAMA Psychiatry.

Kenneth L. Subotnik

To compare the efficacy of long-acting injectable antipsychotics with oral antipsychotics, researchers randomly assigned 86 patients with recent onset of schizophrenia to a long-acting injectable formulation of risperidone or an oral formulation of risperidone for 12 months. Participants in each treatment group were then randomly assigned to cognitive remediation to improve cognitive functioning or healthy-behaviors training to improve lifestyle habits and well-being. Three patients refused long-acting injectable treatment.

Patients who received long-acting injectable risperidone had lower rates of psychotic exacerbation and/or relapse compared with patients who received oral risperidone (5% vs. 33%; P < .001).

Patients who received injectable risperidone had better controlled mean levels of hallucinations and delusions throughout follow-up (P = .01).

Cognitive remediation and healthy-behaviors training did not significantly affect rates of psychotic relapse, psychotic symptom control or hospitalization and there were no significant associations between the psychosocial and antipsychotic treatments, according to researchers.

Patients who receive oral medication were more likely to discontinue treatment due to inadequate clinical response (P = .01).

Medication adherence was better among patients who received long-acting injectable risperidone vs. those who received oral risperidone (P < .001). Further, medication adherence was associated with prevention of psychotic exacerbation and/or relapse (P = .003) and control of breakthrough psychotic symptoms (P = .04).

“If this trifecta of improved psychotic symptom control, cognition and intracortical myelination can be replicated in longer longitudinal studies of patients with a first episode of schizophrenia, it would suggest that the use of long-acting injectable antipsychotics early in schizophrenia can modify the trajectory of the disorder and lead to better long-term outcomes. This possibility would be a ‘game changer’ for the field,” Subotnik and colleagues concluded. – by Amanda Oldt

Disclosure: Subotnik reports serving as a consultant to Janssen, being on the speakers bureau for Otsuka and receiving research support from Janssen and Genentech. Please see the full study for a list of all other authors’ relevant financial disclosures.