LAIAs superior
Of the total study population, 23,719 patients (33.7%) were prescribed both OAs and LAIAs (mean age, 41.7 years). Of these participants, 15.4% died during the observation period.
The mean duration of follow-up was 12.5 years. The mean duration of exposure to OAs alone was 5 years; for LAIA exposure alone, 1.4 years; and for OA plus LAIA exposure, 4.4 years.
During the observation period, almost all individuals (92.8%) had one or more ED visits, and most (88.4%) had one or more hospitalizations for any psychiatric disorder. Over three-quarters (77.5%) were hospitalized for schizophrenia, and a small percentage (6.1%) had an incident suicide attempt.
Almost all patients experienced EPS (93.5%); over half (64.9%) were hospitalized for somatic disorders; and 15.6% were hospitalized for cardiovascular diseases.
After adjustment, compared with OAs, use of LAIAs was associated with a significantly lower risk for most outcomes.
There were no differences between LAIAs and OAs regarding ED visits.
The reduction in EPS suggests that LAIAs “were not associated with a higher risk of those adverse events than OAs,” the investigators write.
When the patients were stratified by initiation time of LAIAs, early initiators had 76% fewer hospitalizations for schizophrenia during LAIA vs OA treatment (IRR, 0.24; 95% confidence interval, 0.21-0 .27), while late initiators of LAIAs had 55% fewer hospitalizations for schizophrenia (IRR, 0.45; 95% CI, 0.40-0.49), “suggesting that early LAIA initiators could have greater reduction in disease relapse,” the researchers noted.
Participants with comorbid substance use had a significantly lower risk for hospitalizations for any cause, hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, hospitalizations for somatic disorders, incident suicide attempts, and EPS during the time they were treated with LAIAs versus the time they were treated with OAs.
Older adults (> 65 years) treated with LAIAs had a lower risk for ED visits, hospitalizations for any cause, hospitalizations for psychiatric disorders, and hospitalizations for schizophrenia. They were not at increased risk for hospitalizations for somatic disorders or cardiovascular diseases.
There was, however, a higher risk for EPS during initial treatment with LAIAs, so “caution should be exercised when initiating LAIAs” in older individuals, the investigators wrote.
Cited study limitations include the fact that pooled estimates were used for all LAIAs, rather than for individual antipsychotics. Additionally, the dose of these antipsychotics “was not accounted for because the disease information was recorded in a different way for LAIAs and OAs.”
Proactive approach
Commenting on the study, Brittany Gouse, MD, assistant professor at Boston University School of Medicine and a psychiatrist in the wellness and recovery after psychosis program, Boston Medical Center, said the study “adds to the growing body of evidence supporting the longitudinal benefits” of LAIAs for patients with schizophrenia spectrum disorders.
“In particular, there may be a unique benefit to transitioning to long-acting injectable antipsychotics within the first 2 years of illness,” said Dr. Gouse, who coauthored an accompanying editorial and was not involved with the research.
She also called the study “important,” because it suggests that early initiation of LAIAs “may serve as an important tool to reduce morbidity and bridge the premature mortality gap in schizophrenia.”
Dr. Gouse emphasized the importance of prioritizing “tertiary prevention” right from the onset of psychotic illness.
“Clinicians must take a proactive approach and include long-acting antipsychotics in shared decision-making conversations with patients within the first few years of illness,” she said.
The study was funded by the Excellent Young Scientists Fund of the National Natural Science Foundation of China. Dr. Chan received grants from the National Natural Science Foundation of China during the conduct of the study; nonfinancial support from the Wellcome Trust; grants from the Research Grants Council, the Research Fund Secretariat of the Food and Health Bureau, the National Health and Medical Research Council (Australia), the narcotics division of the Security Bureau of Hong Kong SAR, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Janssen, Pfizer, Takeda, and Novartis; and personal fees from Pfizer, Novartis, and the Hong Kong SAR Hospital Authority outside the submitted work. The editorialists reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.