Combination of Long-Acting Injectable Antipsychotics and Oral Antipsychotics

A retrospective review of charts by Fuminari Misawa, MD, PhD, and colleagues indicated that the combination therapy of long-acting injectable antipsychotics (LAI-APs) and oral antipsychotics (OAPs) for maintenance treatment of schizophrenia is common in real-world settings, despite LAI-APs having been considered a stand-alone treatment option. Results of the study were published in the Journal of Clinical Psychopharmacology.

Researchers conducted the retrospective chart review alongside a survey to investigate prescribers’ attitudes toward the combination therapy. Patients treated with LAI second-generation antipsychotics (LAI-SGAs) for one month or longer were divided into monotherapy and combination therapy groups. Information on age, sex, primary psychiatric diagnosis, and concomitant psychotropic medications were analyzed.

Of the 132 patients, 39 (29.5%) received the combination therapy of LAI-SGAs and OAPs. Long-acting injectable risperidone had a significantly stronger association with receiving the combination therapy relative to LAI aripiprazole.

Olanzapine was the most common OAP in combination therapy cases. Only eight patients (20.5%) received a combination including the same type of OAPs as LAI-SGAs. More than 60% of the patients used multiple OAPs before the initiation of LAI-SGAs.

Psychiatrists generally prescribed LAI-SGAs due to concerns regarding treatment adherence. Meanwhile, OAPs were mainly prescribed to patients in the combination therapy group because of insufficient dose of LAI-SGAs. The providers claimed that adherence to OAPs was 80% or higher in two-thirds of the patients in the combination therapy group, according to the authors.

Reviewers concluded that the combination of LAI-SGAs and OAPs is, in-fact, commonly conducted in real-world clinical practice. Considering LAI-APs were often introduced after treatment adherence concerns, the authors suggest that “clinicians should carefully monitor patients’ adherence to OAPs concurrently used with LAI-APs.”

Source: Journal of Clinical Psychopharmacology