番茄社区

COLORADO SPRINGS, Colo. -- Using long-acting injectable (LAI) antipsychotic therapies rather than oral agents for schizophrenia was tied to demographic and clinical factors, a single-center retrospective cohort study suggested.

Younger age (OR 0.97, 95% CI 0.95-0.99, P=0.01) predicted which patients received LAI antipsychotic treatment, reported Emily Groenendaal, MD, of the New York Medical College in Valhalla.

Length of first admission also predicted LAI use (OR 1.06, 95% CI 1.03-1.09, P<0.001), Groenendaal said during a presentation at the 2022 Neuroscience Education Institute Congress.

Patients receiving LAI treatment had greater illness severity, noted by longer length of initial admission (LAI group 23.0 days vs oral group 13.0 days, P<0.001) and higher rates of complex discharge (LAI group 30.1% vs oral group 6.5%, P<0.001), Groenendaal said.

Neither cost nor socioeconomic status likely affected these findings because more than 90% of the patient population held public insurance and there were no differences between groups in terms of insurance status, she noted.

"We had a lot of direct indicators of illness severity," Groenendaal told 番茄社区. "For instance, most seen in the literature is your length of first admission -- if you have a long admission to an inpatient unit, that's a direct indicator of increased illness severity -- but also things like a complex discharge, were you set up with something more intensive than just outpatient therapy."

"To start with the predictors, we found that the only predictors of receiving an LAI was younger age and a longer length of admission," she said. "This was nice because longer length of admission indicates greater illness severity, if you have greater illness severity -- more difficulty with medication adherence -- you should absolutely receive an LAI. The literature is moving toward offering LAIs to younger and younger patients to kind of mitigate the disease course."

The researchers also analyzed predictors of patients using first- or second-generation antipsychotics, either LAIs or oral. Older age was a significant predictor of first-generation LAI use, and this group was more likely to have a co-occurring substance use disorder, they reported.

For first- and second-generation oral antipsychotics, first-generation oral therapies were more likely to be used by patients who were older and female. Patients using first-generation oral treatments were also more likely to have complex discharges and longer length of first admission.

Groenendaal noted that it's possible providers of older patients who were taking first-generation antipsychotics -- especially those with well-controlled symptoms -- might not want to switch those patients to second-generation antipsychotics.

"In terms of receiving first-generation LAI, we found that actually older age was a significant predictor, which doesn't really sit too well because first-generation can generally have a higher instances of EPS [extrapyramidal symptoms] or movement disorders," Groenendaal said.

To identify predictors, Groenendaal and co-authors matched medical charts from 246 patients diagnosed with schizophrenia or schizoaffective disorder at the Westchester Medical Center Health System in Valhalla, New York, in 2019.

The cohort was diagnosis-matched between patients who had received LAI antipsychotics (n=123) and patients who received oral antipsychotics (n=123). All sociodemographic and clinical factors, including indicators of illness severity, were collected from patients' medical records.

The findings highlighted several revelations about the institution's prescribing patterns for this patient population and sparked conversations around how decisions are made when prescribing patients LAIs or oral antipsychotics, Groenendaal noted.

For patients with severe illness, LAIs may be the best choice, "but we are educators [and] we should absolutely be presenting our patients with all options and kind of helping them choose," she said.

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