Early Use of Long-Acting Injectable Antipsychotics in Bipolar I Disorder: an Expert Consensus

This work was supported by Otsuka Pharmaceutical Development & Commercialization Inc. (Princeton, NJ, USA) and H. Lundbeck A/S (Valby, Denmark) Introduction: Long-acting injectable antipsychotics (LAIs) are currently under-utilized in the treatment of bipolar I disorder (BP-I), particularly in early-stage disease, despite supporting evidence. Methods: A round-table meeting of expert advisors discussed barriers and opportunities for early use of LAIs for BP-I. Results: LAIs are rarely prescribed for treating BP-I unless a patient has very severe symptoms, is non-adherent to oral medication, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., approval status and healthcare infrastructure), primary barriers to the appropriate use of LAIs, particularly in early-phase BP-I, were identified as both attitudinal and knowledge/experience-based. Healthcare providers might have a preconceived notion that patients prefer oral antipsychotics and, as a result, might not ask them directly. Additionally, because LAIs have historically been limited to the treatment of schizophrenia, healthcare providers might be unaware of the benefits of LAIs in treating BP-I. Compared to oral antipsychotics, LAIs are associated with improved treatment adherence, which may support better patient outcomes (e.g., reduced relapse and hospitalization) and reduced burden on healthcare systems. The experts were in consensus that it is critical to involve all stakeholders who are part of the patient journey (healthcare providers, patients, and their supporters) in a shared decision-making process, as early as possible. To facilitate widespread acceptance of LAIs, clinical and database studies could bridge knowledge gaps. Conclusion: This consensus discusses the benefits of LAIs in the management of BP-I and identifies barriers to use, while providing potential solutions to aid key stakeholders in making informed treatment decisions.