Preventing Relapse in Schizophrenia: Oral vs. Long-Acting Injectable Therapies
Schizophrenia is a chronic illness that is associated with functional impairment, a decreased quality of life, and high caregiver burden.1 This devastating disease is often marked by periods of remission followed by periods of relapse, and is frequently associated with poor long-term outcomes.2 It has been found that 27% of schizophrenic patients will relapse within 7 to 12 months after stabilization on an antipsychotic medication and 80% will relapse within 5 years of their first initial episode.1 Periods of relapse not only often require hospitalization, but can also lead to a reduced treatment response and a further deterioration of mental functioning.1 Relapses are not only detrimental to a patient's long-term functioning, but are also difficult for caregivers as well as the mental health care system.3 Because of this, the prevention of relapse is often a fundamental objective in the treatment of schizophrenia.1
Unfortunately, preventing relapse in schizophrenic patients is very challenging, mainly due to poor medication adherence within this patient population.1 Studies show that patients who fail to adhere to their treatment regimens have approximately five times greater risk of relapse compared to those who continue treatment as prescribed. Because of this, several strategies have been employed to help increase medication adherence for patients with schizophrenia. Of these strategies, the use of long-acting injections of antipsychotic medications (LAI) is probably the simplest and most popular approach to promote adherence in these patients.
LAI not only increase patient adherence, but also have several other advantages compared to oral antipsychotics.1 One major benefit of LAI is that they require regular contact with caregivers and physicians. Because of this, practitioners are able to identify medication effectiveness, true lack of response, and any other issues that a patient may be experiencing. Other advantages of LAI include increased bioavailability, avoidance of first-pass metabolism, more stable medication concentrations, and a decreased risk of voluntary overdose. Although LAI are known to enhance treatment adherence in schizophrenic patients, there is ongoing debate regarding the efficacy of these medications versus oral antipsychotics. Several studies comparing the efficacy of LAI to oral antipsychotics or placebo have recently been published and are discussed below.