Long-Acting Injectable Antipsychotics: Practical Considerations and Impact on Adherence in Schizophrenia

Successful management of schizophrenia remains an elusive target for many clinicians. High rates of undertreatment and nonadherence result in poor outcomes among many patients, with significant consequences for morbidity and mortality. In addition to a timely diagnosis, antipsychotic treatment is essential to achieving and maintaining remission, maximizing quality of life and adaptive functioning, and maintaining recovery from debilitating effects of disease. Antipsychotics are the mainstay of schizophrenia pharmacotherapy, where long-acting injectable, or LAIs, formulations of established antipsychotics provide a means to address the significant unmet need regarding medication adherence within schizophrenia management. Although LAIs have been designed to improve outcomes and address persistent treatment barriers including adherence challenges, their uptake into clinical practice has been suboptimal despite the considerable evidence establishing their efficacy and safety. Furthermore, a variety of LAI dosing options are available, allowing for individualized therapeutic regimens to address patient-centric issues of tolerance and adherence. Therefore, it is critical that clinicians be able to differentiate among agents, especially with respect to tolerability, efficacy in treating a broader spectrum of symptoms, and implications for individual patient treatment plans. Thus, to facilitate the optimal implementation of these important agents and overcome persistent barriers to successful schizophrenia treatment, clinicians require continuing education on the optimal use of LAI therapy to address schizophrenia. This educational curriculum was designed to meet learning objectives associated with schizophrenia identification and treatment. After completing the education, clinician learners were expected to be able to : • Outline the role that LAIs can play in patient preferences and overcoming medication adherence challenges for patients with schizophrenia; • Discern differences among the LAIs in terms of pharmacodynamics, pharmacokinetics, indications, and dosing procedures and their implications for patient selection and personalized treatment; and • Implement strategies for patient-centric communication to facilitate patient acceptance of LAIs. Throughout the curriculum, significant increases were demonstrated across survey questions designed to assess knowledge and competence in clinician behavior and practice. Overall, there was a 94 percent increase in learner’s knowledge following participation in any of the educational programs within the curriculum compared to pre-conference. Clinician learners increased their knowledge with regard to evaluating the pharmacology, mechanisms of action, safety and efficacy, and administration considerations associated with LAIs.Clinician learners also provided insight into what their intended changes to practice would be following the education, including initiating LAI-based therapy in appropriate patients to improve adherence, initiating LAI-based therapy earlier in the course of treatment, and discerning which LAI is best for a particular patient based on current guidance and a more robust understanding of LAI formulation, dosing, and pharmacokinetics. Novel LAIs have the potential to significantly impact outcomes among patients with schizophrenia through supporting improved adherence rates. However, their uptake into clinical practice has been low. To overcome barriers to the use of these important agents, psychiatry clinicians require ongoing education regarding their differing pharmacologic properties, their implications for individualized patient care, their best-practice use, and communication tactics to facilitate patient acceptance of LAIs. Although a majority of clinicians have expressed a wish to seek out more information on LAI use, among the most significant ongoing barriers to the use of LAIs in schizophrenia management are discerning the differences among the LAIs in terms of pharmacodynamics, pharmacokinetics, indications, and dosing procedures as well as understanding their respective implications for patient selection and personalized treatment. Prior to engaging with the activities, clinicians displayed low levels of knowledge regarding the pharmacology of current medications, especially newly approved and investigational LAIs. In addition, clinicians displayed low levels of knowledge regarding the implementation strategies for patient-centric communication to facilitate patient acceptance of LAIs. Following the activities, however learners are less likely to indicate a lack of knowledge, feeling more confident in their ability to properly use LAIs in their clinic, potentially indicating educational success. Therefore, continuing education on LAI use in the treatment of schizophrenia continues to be warranted.