A Systematic Literature Review of Schizophrenia Clinical Practice Guidelines: Recommendations on use of Long-acting Injectable Anti-psychotic Medications

Background and Objectives: Many clinical practice guidelines (CPGs) on the treatment of schizophrenia have been updated. Aiming to review current CPGs, focusing specifically on long-acting injectable antipsychotics (LAIs) that traditionally have been recommended after relapses and/or antipsychotic non-adherence, a systematic literature review (SLR) was conducted.

Methods: Systematic searches were conducted in MEDLINE, /Embase and guideline body's websites to identify English-language schizophrenia CPGs published from 01.01.2014-11.19.2019. The SLR was conducted following PRISMA guidelines (2009). Dual-independent screening was used at both the abstract and full-text levels. Data were captured from each included guideline by a single reviewer with validation by a second reviewer. The AGREE II tool (2010) was used to assess the quality and reporting of CPGs.

Results: The SLR identified 19 CPGs on the treatment of schizophrenia (US=7, UK=3, international=3, Australia/New Zealand=1, Canada=1, France=1, Italy=1, Poland=1, Singapore=1). All guidelines, except one (Italy), referenced LAIs. CPGs mainly recommended considering LAIs in cases of non-adherence, patient preference, or in case of inefficacy to oral antipsychotics (OAPs). Definitions of non-adherence were not typically reported. Only the Florida Medicaid CPG recommended LAIs as a first step equivalent to OAPs after initial OAP response and tolerability, independent of nonadherence or other clinical variables. Five (26%) CPGs recommend considering LAIs across the entire illness course, starting in the first schizophrenia episode.

Conclusions: Current schizophrenia guidelines have changed to recommend LAIs as early as during the first illness episode. However, only one CPG recommends LAIs independent of adherence status to prevent future non-adherence related relapses/illness deterioration.