Growing Evidence Supports Use of Long-Acting Injectable (LAI) Antipsychotics for Schizophrenia in Adults

National Council for Behavioral Health Guide to Long-Acting Medications for Providers and Organizations (2019)

The National Council for Behavioral Health supports the safe and effective use of LAIs by encouraging mental healthcare professionals to utilize LAIs as an earlier treatment option rather than using them1 only after multiple negative outcomes such as failed oral medications, multiple relapses, or hospitalizations.

Excerpts from The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition regarding long-acting injectable antipsychotics (2020)

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Patient Preference

"Clinical experience suggests that many patients are cooperative with and accepting of an LAI [long-acting injection] antipsychotic medication as part of a treatment plan, particularly when the option of an LAI and the pluses and minuses of an LAI antipsychotic are reviewed in the context of shared decision making.

"Attitudes about LAIs are typically more positive among patients who have previously received or currently receive an LAI antipsychotic medication than in those who have never been treated with an LAI medication.

"Many patients prefer the convenience of receiving an infrequent injection rather than needing to remember to take oral medications. . . . On the other hand, some patients may not wish to experience the discomfort associated with receiving injections of medications."2

Earlier Discussion

“Although LAI antipsychotic medications have typically been used in individuals with multiple episodes of schizophrenia, some studies have used an LAI antipsychotic formulation earlier in the course of illness when rates of poor adherence may be greater. Earlier discussion of an LAI may also be considered in individuals who are at increased risk of poor adherence due to a limited awareness of needing treatment or a co-occurring substance use disorder.”2

Patient Type

“Discussions about LAI [long-acting injection] antipsychotic medications often occur in patients who have had difficulty in adhering to oral medications. However, such discussions can also take place at other junctures.

“For example, if an individual has not responded to treatment with an oral antipsychotic medication, a trial of an LAI may be warranted because breaks in the continuity of oral medication therapy can be unrecognized.

“An LAI formulation of an antipsychotic may also be considered when patients are transitioning between settings (e.g., at inpatient discharge, upon release from a correctional facility) when future adherence is uncertain and the risk of reduced adherence may be increased.”2

Patient Outcomes

"Use of an LAI antipsychotic medication in the treatment of schizophrenia may be associated with improved outcomes.

"Although meta-analyses of head-to-head [randomized control trials (RCTs)] comparing LAI to oral antipsychotic and other meta-analyses of RCTs do not show evidence of benefits from LAIs relative to oral antipsychotic medications, observational data from nationwide registry databases, cohort studies, and 'mirror image' studies suggest that use of LAI antipsychotic agents as compared to oral antipsychotic medications are associated with a decreased risk of mortality, reduced risk of hospitalization, and decreased rates of study discontinuation (including discontinuation due to inefficacy)."2

Mortality was not studied or evaluated with INVEGA SUSTENNA®.

References: 1. National Council for Behavioral Health. Guide to Long-acting Medications for Providers and Organizations. thenationalcouncil.org. Published June 5, 2019. Accessed October 29, 2020. https://www.thenationalcouncil.org/topics/long-acting-medications/ 2. The American Psychiatric Association. Practice Guideline for the Treatment of Patients With Schizophrenia. Published September 2020. Accessed October 29, 2020. https://doi.org/10.1176/appi.books.9780890424841