Drivers of Prescribing Long-Acting Injectable Antipsychotics to Patients with Schizophrenia

Long-acting injectable (LAI) antipsychotics are recommended by clinical guidelines for patients with schizophrenia who struggle with adherence and/or recurrent relapses. However, LAI utilization remains low. This study aimed to understand drivers of prescribing LAIs to patients with schizophrenia in real-world practice.

A cross-sectional survey of psychiatrists was conducted across the US, France, Spain, Japan and China between July-December 2019. Psychiatrists completed a survey capturing their attitudes on managing schizophrenia and provided profiles for up to 10 consulting adult patients with schizophrenia.

466 psychiatrists completed the survey and provided information on 4,237 patients; 1,132 were receiving LAIs. LAI patients were more frequently recorded as “moderate-amongst the most extremely ill” according to Clinical Global Impression-Severity scale (68% vs 51% non-LAI) and “moderate-severe” for overall level of function (61% vs 48% non-LAI). LAI patients had longer duration of illness (mean 11.1 vs 8.2 years), experienced more relapses/hospitalizations since diagnosis (mean 3.0 vs 1.6) and had more suicide attempts ever (mean 0.44 vs 0.30) than non-LAI patients. LAIs were utilized more in patients unable to finish education (40% vs 28%) and unemployed (66% vs 59%). Improvement of adherence (64%) and prevention of relapse/hospitalization (60%) were amongst the most common reasons for prescribing LAIs. Only 1% patients requested LAIs, with 85% of these requests granted by psychiatrists.

Adherence improvement and relapse prevention were common reasons for prescribing LAIs and majority of LAI patients had more severe schizophrenia. As LAI patients had longer duration of illness, future studies evaluating earlier use of LAIs are warranted.