Treatment guidelines addressing LAIs

Video transcript

Speaker 1:

Navigating Long-Acting Injectable Conversations to Achieve Longer Dosing Intervals in Adult Patients With Schizophrenia, a virtual national broadcast for pharmacists in mental health. This video was developed from virtual sessions previously recorded in June 2022. Any audience participation and/or interactivity will not be enabled or be available as part of this presentation. Our guest speaker is Dr. Alberto Augsten, pharmacy clinical manager and board-certified clinical toxicologist at Memorial Regional Hospital in Hollywood, Florida.

Dr. Alberto Augsten:

As Mary said, let's go ahead and begin this very interesting discussion on navigating long-acting injectable conversations to achieve longer dosing intervals in adult patients with schizophrenia. So once again, thank you and welcome to the program. It must be stated, this is a promotional educational activity brought to you by Janssen. It's not certified for continued medical education. I am a paid speaker for Janssen, and we're presenting on behalf of Janssen, and must present information in compliance with the FDA.

Now, with that being said, pharmacists play a key role. We know we're delaying the start. Now, what are the guidelines and guidance telling us? We're going to reflect on the APA and the National Council for Mental Wellbeing. In looking at the APA, really highlighting in orange, making a suggestion that LAIs may be suitable for adult patients with schizophrenia for the following reasons that we know now to be true. This is a recent update last year that came out with the APA: “If the patient prefers such treatment.” That's important, because at the end of the day, the patient has a choice. The patient needs to be engaged in treatment. There needs to be a therapeutic alliance if we really want best outcomes.

Now, if the patient has a history of poor adherence, another reason to use an LAI—and now we have plenty of data to suggest that that's something that our patients face. Let's be honest, most of us struggle with adherence related to our own medications that we take orally. So this is an issue. Poor adherence plays a role.

If the patient is at risk for reduced adherence due to any one of the following reasons: One, transitioning between settings, such as inpatient or released from a correctional facility. Those are the patients we're seeing in our practice. Those are the patients we're seeing on the inpatient side. Or they have a co-occurring substance use disorder. Or they have limited awareness of needing treatment. So various factors—not this potential that they may have an adherence issue, they may end up with four different regimens and multiple relapses—no, these are clear defined reasons of why your patient should be initiated potentially on an LAI, and educated about LAIs. So earlier discussion of LAIs should be considered for patients with limited awareness or co-occurring substance use disorders. Either one.

Now, transitioning over to the National Council for Mental Wellbeing, and looking at the part in orange, to utilize an LAI as an earlier treatment option rather than using them only after multiple negative outcomes, such as failed oral medications, multiple relapses, or hospitalizations. Meaning: Why wait? Why are we waiting so long? And the discussion should be happening much sooner. So now we know we have this delay in start, and we have this guidance and guidelines saying we should be using LAIs much sooner in the disease course.