Long-acting injectable antipsychotics lower hospital readmission rates for schizophrenia

Key takeaways:

• Fewer than 2% of patients who received long-acting injectable antipsychotics were readmitted vs. 8.3% of those who received oral antipsychotics.
• Most long-acting injectables were obtained through a free trial program.

Long-acting injectable antipsychotic medications reduced hospital readmission rates among patients with schizophrenia and schizoaffective disorder compared with oral antipsychotic medications, according to a recent study.

“More than one-third of preventable readmissions are attributed to medication nonadherence across areas of medicine,” Pragya Thaman, PharmD, Johnson & Johnson Global Medical Affairs Oncology Fellow, and colleagues wrote. “Long-acting injectable medications may alleviate some of these burdens but come with a high upfront cost.”

Thaman and colleagues who conducted the single-center retrospective study examined 30-day readmission rates over a 3-year period among patients who were given long-acting injectable antipsychotics vs. oral antipsychotics upon discharge. The researchers also evaluated the effect of chlorpromazine equivalent dosage and the use of anticholinergic medications to treat extrapyramidal symptoms.

Of the 343 patients (mean age, 40.3 years; 55.4% male) in the study, 62.7% were diagnosed with schizophrenia and 37.3% were diagnosed with schizoaffective disorder.

Overall, clinicians discharged 103 patients (30%) with a long-acting injectable antipsychotic medication. The most common of these included aripiprazole lauroxil (Aristada, Alkermes; 45.6%), followed by haloperidol decanoate (35%) and paliperidone palmitate (Invega Sustenna, Janssen; 15.5%). Two-thirds (64%) of these medications were obtained through a hospital inpatient free trial program.

The majority of patients (204; 70%) received oral medication upon discharge. Most received either risperidone (27.5%) or olanzapine (21.3%).

Twenty-two patients (6.4%) were readmitted within 30 days of their original hospital visit. Only two patients (1.9%) who received long-acting injectable antipsychotics were readmitted, compared with 20 (8.3%) patients who received oral antipsychotics (P = .03). More patients who were readmitted had schizoaffective disorder than schizophrenia (57% vs. 43%).

Thaman and colleagues noticed a significant difference in the average chlorpromazine equivalent dose between patients who received a long-acting injectable vs. an oral antipsychotic (477.3 mg/d vs. 278.6 mg/d; P < .001). However, there was not a significant difference in prescriptions to treat extrapyramidal symptoms between the two groups (95% CI, 0.9-2.66).

“Long-acting injectable antipsychotics showed a statistically significant reduction in 30-day rehospitalizations as compared with oral antipsychotics,” the researchers wrote. “In addition, prescribers were comfortable utilizing medications obtained from free trial replacement programs, which can help offset the upfront cost while also not being billed to patients. Hospitals with limited formularies or funding may find these free trial programs useful to increasing medication access for vulnerable patients.”