番茄社区

In this fourth and final episode, 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 how the COVID-19 pandemic affected prescription trends for long-acting injectable (LAI) antipsychotics, as 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: Dr. Meyer, tell us a little bit about COVID-19 and the pandemic -- how did it affect prescribing and adherence?

Meyer: Well, as Dr. Kane mentioned, one of the main ways we can minimize nonadherence is using a long-acting injectable. Some investigators actually surveyed people in November/December of 2020 about how COVID impacted their LAI prescribing, and they presented this data at Psych Congress just recently.

So, this was a survey of over 400 healthcare providers, mostly physicians, but again, psychiatric nurse practitioners, PAs as well -- end of 2020. Many of them said, COVID-19 did not change [our] prescribing trends too much. You were still able to get people LAI treatment. But they did acknowledge that there were barriers. Sometimes there wasn't staff, the clinic was closed. Patients occasionally had trouble with transportation. But their expectation was overall that they might be able to give more in 2021. And they really noted the fact that particularly because many people really do not want to go to a hospital during this era of COVID, they found the discussion perhaps a little bit easier, assuming they could work out some of the procedural issues about getting patient and medication in the same room.

The underlying hypothesis always is that if we can give people continuous medication, they don't have to struggle with oral adherence issues. And this is common to all chronic illnesses, as was alluded to by Dr. Kane. For the hypertension clinic, [if] you go to the diabetes clinic, it's the same issue. Oral nonadherence and a chronic illness is about 50%, and it's no different for schizophrenia. But if we can get people on long-acting injectable therapy, we really feel like we can mitigate this.

And in this survey, 43% of the providers said they expected their long-acting injectable use to increase in 2021. And it talked about the fact that now people are vaccinated, staff is often in the clinic, patients themselves have been vaccinated, they feel more comfortable about traveling. I think that it's really an opportunity to have a discussion in a way that may have been difficult in the past about how can we keep you from relapsing, how can we offer you options, which may be convenient? And I think that's part of the discussion with LAIs, is one of convenience. It's not a punishment, it's convenient.

You can get an injection every 1 month, 2 months, 3 months, 6 months. It will mitigate relapse, not reduce it to zero, but certainly lessen the chances. Mitigate nonadherence and thereby keep you from perhaps having to go to the hospital with all the concerns that may be involving, even now, even among vaccinated people, there's still a concern about being out in public and exposure to COVID.

Citrome: You know, some of our communities near where I live decided to no longer be open, even for injections. This was especially so at the beginning of the public health emergency, and they essentially told their patients, I'm going to send an e-prescription to the pharmacy for the oral equivalent of what you've been getting as an injection. And that's what we're going to do. Unfortunately, it didn't work out all that great. People were placed initially on the long-acting injectable or they elected to receive the long-acting injectable -- I should say it that way -- for good reason. And so this was a disaster for many people.

We actually did, in our community ourselves, we kept open the injection clinic, so to speak, and actually used it as an opportunity to switch people over from the every-2-week injectables to the every-month injectables, or to the every-2-month or every-3-month. And that actually made a lot of sense for many of our patients. So this also was an opportunity for more rational care.

Meyer: I agree. And again, as Dr. Kane was alluding to, sometimes we forget that many people may elect to use an LAI just for the sake of convenience. It's convenient in terms of not having to worry about the pharmacy mailing a prescription, or going to pick it up, plus the convenience, as he mentioned, of not having to wrestle with that daily decision making of should I, or shouldn't I. Or they just have cognitive issues, they forget. They forget, and then they suffer the consequences. Giving them an LAI option maybe liberates them from a lot of those concerns.

Kane: And also not having the family dynamic that sometimes evolves, when the family is concerned about adherence and the patient can get annoyed about the family nudging them or whatever. And we can eliminate that with a long-acting injectable. I also hope that someday there'll be more opportunity to give these injections as part of a home visit that would alleviate some of the burden for travel and things like that. And if we can avoid 1 or 2 days in the hospital, that relieves a lot of financial burden that could hopefully be used to support some of these options.

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

Watch the third episode of the roundtable: The Role of Long-Acting Injectable Drugs for Schizophrenia

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