Increased Clinical Use of LAIs Show Improved Outcomes in Schizophrenia Treatment

For the maintenance treatment of schizophrenia, long-acting injectable antipsychotics (LAIs) were associated with a lower risk of hospitalization or relapse than oral antipsychotics in a comparative meta-analysis of 137 studies spanning 3 different study designs. Researchers published their findings in The Lancet Psychiatry.

“Although study designs have strengths and weaknesses, including potential low quality of observational studies, we consistently identified significant benefit with LAIs versus oral antipsychotics in preventing hospitalization or relapse, in settings ranging from restricted research (randomized controlled trials) to real-word application (cohort and pre–post studies),” researchers reported.

Comparisons of LAIs and oral antipsychotics in patients with schizophrenia have previously yielded inconsistent results across study designs. To better inform clinical decision-making, researchers conducted a comprehensive systematic review and subsequent meta-analysis that focused on 32 randomized controlled trials, 65 cohort studies, and 40 pre–post studies.

Discussing Long-Acting Injectable Antipsychotics for Patients with Schizophrenia

Studies each lasted 6 months or more and, in all, included a total 397,319 adults with schizophrenia and related disorders. Across study designs and within each study design, the quality in terms of risk of bias varied from low to high.

When researchers meta-analyzed the risk ratio for hospitalization or relapse, with hospitalization used preferentially over relapse, they found that LAIs were linked with a lower risk of hospitalization or relapse than oral antipsychotics in each of the study types. Risk ratios were 0.88 in randomized controlled trials, 0.92 in cohort studies, and 0.44 in pre–post studies, according to the findings. When researchers switched the preferential order to risk of relapse over hospitalization, the association of LAIs with lower risk remained across study designs.

In secondary outcomes involving effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes analyzed by study design, LAIs were more beneficial than oral antipsychotics in 18.3% of 328 comparisons, and no different in 76.8% of 252 comparisons, analysis showed. In just 4.9% of 16 comparisons, oral antipsychotics were more beneficial than LAIs.

“Our findings suggest,” researchers concluded, “that increased clinical use of LAIs could improve outcomes in schizophrenia.”

Reference

Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre–post studies. Lancet Psychiatry. 2021;8(5):387-404.