Switching to long-acting injectable (LAI) antipsychotics or antipsychotic polytherapy in early nonresponders appears to help prevent treatment failure in acutely hospitalized patients with schizophrenia, according to study results published in the Asian Journal of Psychiatry.

“The risk of treatment failure was about 19% and 17% lower in patients treated with LAIs and antipsychotic polytherapies except polytherapy involving clozapine, respectively, compared to patients treated without them,” researchers wrote.

The study included 1011 patients newly admitted to 12 psychiatric emergency hospitals in Japan between September 2019 and March 2020. Researchers investigated the real-world effectiveness of various treatments over 1 year of follow up. Because combining antipsychotics with clozapine is not permitted in Japan, antipsychotic polytherapy in the patient population did not include any therapies involving clozapine.

Increased Clinical Use of LAIs Show Improved Outcomes in Schizophrenia Treatment

During follow-up, 58.2% of patients experienced treatment failure, researchers reported. Among them, 513 patients were rehospitalized, 47 patients were never discharged from the hospital, 17 patients discontinued medication, and 11 patients died.

A lower rate of treatment failure was significantly associated with switching to LAIs (researchers reported a hazard ratio of 0.810) and antipsychotic polytherapy (hazard ratio of 0.829), the study revealed. The risk of treatment failure was 48% lower in patients prescribed the combination of olanzapine and paliperidone compared with patients prescribed antipsychotic monotherapy.

“Although the study results from real practice may be generalized only to acutely hospitalized patients with schizophrenia, they are consistent with the previously reported all-hospital-treated patients’ databases in Sweden,” researchers wrote. “Longer term follow-up studies with larger numbers of acutely hospitalized patients with schizophrenia are required.”

Reference

Hatta K, Katayama S, Ishizuka T, et al. Real-world effectiveness of antipsychotic treatments in 1011 acutely hospitalized patients with schizophrenia: a one-year follow-up study. Asian J Psychiatr. Published online November 6, 2021. doi: 10.1016/j.ajp.2021.102917