番茄社区

In this third of four exclusive episodes, 番茄社区 brought together three expert leaders in the field -- moderator , of New York Medical College in Valhalla, is joined by , of Northwell Health in Long Island, New York, and , of the University of California San Diego -- for a virtual roundtable discussion about studies on long-acting injectable (LAI) antipsychotics that were reported at this year's Psych Congress, held virtually and in San Antonio.

Following is a transcript of their remarks:

Citrome: Hello, and welcome to our Psych Congress video roundtable. We'll be talking about hot issues in schizophrenia. Joining me today are Drs. John Kane and Jonathan Meyer. Welcome.

Kane: Thanks very much.

Meyer: Thanks for having me, Les -- really appreciate it.

Citrome: You know, this year at the U.S. Psych Congress there was a lot of discussion about long-acting injectable antipsychotics, a really hot topic. So what's new there, Dr. Kane?

Kane: Well, I think one of the new elements is that there's been an increased emphasis on trying to introduce long-acting injectable formulations earlier in the course of treatment. And there was an interesting dataset that was derived from about 13,000 Medicaid patients in six different states. And what the investigators found was that less than 15% of the patients had been initiated on an LAI prior to demonstrating evidence of non-adherence to oral medication, or prior to being hospitalized or having to go to an emergency room.

So the idea here is that if we can introduce long-acting injectable formulations earlier, we have a better chance of avoiding some of these outcomes. And what they showed was that in the group of patients who did receive these medications earlier, there was actually significant benefits in terms of reducing the risk of hospitalization and ER visits.

So I think many clinicians wait until a patient has demonstrated non-adherence and a resulting relapse or hospitalization before they think about introducing an LAI. And since so many of our patients have difficulty taking their medicine on a regular basis, the notion of introducing an LAI before the relapse has occurred or before the non-adherence has occurred makes a lot of sense.

But I still think clinicians are a little bit uncomfortable with that idea because they're not sure how to present it to the patient. They're afraid that if they suggest a long-acting formulation, they're somehow going to interfere with the therapeutic alliance. In effect they're saying, I don't trust you to take your medicine, I'm going to give you a long-acting formulation. I think that conversation needs to be held in a different way, and that we can say to patients that this is really the best way of treating your illness. We all have trouble taking medicine. I think we need to de-stigmatize non-adherence and just refer to it as human nature. We all have this difficulty. We want to figure out how you can get the benefit of the medicine that we're prescribing.

And then, along those lines, we also saw a presentation of a new formulation of long-acting injectable risperidone, in this case subcutaneous, that can be given either once a month or once every other month. And data were presented on a large study that involved 544 patients who were randomly assigned to placebo or two different injection intervals of this new formulation. And the results were very positive, showing that this was very effective in terms of reducing the risk of relapse and prolonging time to relapse.

So we have more options. Subcutaneous administration is another option. Most of the medicines we have are intramuscular, so some patients are going to be more comfortable with this and some prescribers or physicians or nurses are going to find it somewhat easier to administer. So I think that's good news as well, in terms of increasing our options.

Citrome: You know, I like to offer LAIs as a choice, not just if I have concerns about adherence, but just as a choice of another way of getting one their medicine. And I like to talk about these different formulations, mainly in the basis of amenities of care. Because the molecules may be similar for one formulation to another -- it's risperidone or paliperidone, they're both similar too, but there are different ways of administering it.

So, as you mentioned, subcutaneous is a different way than intramuscular. And then having the different injection intervals is also part of how to make life easier for someone. And there's even now a 6-month preparation of an injectable -- who would have thought that 10 years ago.

Kane: Yeah, I think we're seeing that people are getting more comfortable with this as an option. And in my experience and from the studies that we've done, if the team goes about presenting this in the right way, that most patients are willing to consider it and give it a try. And then once they do that, they find that the pain from the injection is not as great as they thought it might be. And they find it very convenient to be receiving an injection periodically rather than having to remember to take pills every single day. And I think for those people who are ambivalent about taking medicine, having to make that decision every single day, day in and day out, can be quite difficult.

Citrome: Well, thanks so much for that. It was really a hot topic at the Congress, and now we see why.

Watch the first episode of the roundtable: Managing Agitation in Schizophrenia and Bipolar Disorder

Watch the second episode of the roundtable: Emergence of Novel Antipsychotic Agents in Schizophrenia

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