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Objective: Long-acting injectable antipsychotic agents (LAIs) are effective in schizophrenia relapse prevention but are often underutilized. This study aims to understand treatment patterns leading to a successful LAI implementation following schizophrenia diagnosis in a large dataset that included commercially insured patients in the United States., Methods: Patients aged 18-40 years with a first schizophrenia diagnosis (per ICD-9 or ICD-10 criteria), successful second-generation LAI implementation (defined a priori as ≥ 90 consecutive days of use), and ≥ 1 second-generation oral antipsychotic agent (OA) were identified from IBM MarketScan Commercial and Medicare Supplemental databases from January 1, 2012, to December 31, 2019. Outcomes were measured descriptively., Results: Of 41,391 patients with newly diagnosed schizophrenia, 1,836 (4%) received ≥ 1 LAI; 202 (< 1%) met eligibility criteria of successful LAI implementation following ≥ 1 second-generation OA. Median (range) time between diagnosis and first LAI was 289.5 (0-2,171) days, time between LAI initiation and successful implementation was 90.0 (90-1,061) days, and time to LAI discontinuation after successful implementation was 166.5 (91-799) days. Before LAI initiation, 58% received ≥ 2 OAs. For 86% with successful LAI implementation, the implementation was accomplished with the first LAI., Conclusions: In this dataset of mainly commercially insured patients, LAI use in early-phase schizophrenia was very low (4%). For the majority for whom a LAI was successfully implemented per a priori definition, the implementation was accomplished with the first LAI and in a short period of time (90 days). However, even when LAIs were used in early-phase schizophrenia, they were generally not the first therapy, as most patients had several prior OA treatments., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

Objective: Long-acting injectable antipsychotic agents (LAIs) have improved clinical effectiveness and adherence versus oral antipsychotic agents (OAs); however, a minority of individuals with schizophrenia are treated with LAIs compared with OAs. This cohort study aimed to evaluate predictors of initiation of atypical LAIs among patients with newly diagnosed schizophrenia in the United States., Methods: Using claims data from IBM MarketScan Commercial and Medicare Supplemental databases between January 1, 2013, and March 31, 2020, adults with first diagnosis of schizophrenia, ≥ 1 OA claim following diagnosis, and continuous benefits were identified. To evaluate predictors of LAI initiation, a Cox proportional hazard regression model per independent predictors and main outcome (ie, LAI initiation) was performed., Results: Of 3,639 patients with early-phase schizophrenia, 369 (10%) had ≥ 1 LAI claim(s) after ≥ 1 OA claim(s). Several factors present prior to LAI initiation were significantly ( P  < .0001) predictive of LAI initiation: greater monthly OA switches (hazard ratio [95% CI]: 11.39 [7.01-18.51]), unsuccessful OA implementation (3.09 [2.39-3.98]), greater monthly schizophrenia-related hospitalizations (20.83 [14.22-30.51]), and greater monthly schizophrenia-related emergency department visits (4.13 [2.07-8.22])., Conclusions: In this analysis of pharmacy claims records for patients with early-phase schizophrenia, results suggest that LAIs are used less frequently in the early phase than reported in later stages. Their initiation is often reactive to relapse or disease exacerbation, rather than proactive as a relapse-prevention tool for early-phase schizophrenia. These data highlight the underuse of LAIs, particularly in the early phase when they could make the most difference., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

Objective: This systematic review and pooled, patient-level analysis of neuroleptic malignant syndrome (NMS) case reports and series compared NMS characteristics and outcomes during long-acting injectable antipsychotic (LAI) versus oral antipsychotic (OAP) treatment., Data Sources: Two authors independently searched MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO databases for articles in English from database inception until October 9, 2018., Study Selection: Case reports with author-defined NMS during ongoing antipsychotic treatment or within 1 injection interval of LAIs in adults aged 18-65 years., Data Extraction: Demographic, clinical, treatment and outcome data were independently extracted following PRISMA guidelines. NMS severity was rated using the Francis-Yacoub scale. Characteristics and outcomes of NMS were compared when occurring during LAI versus OAP treatment, adjusting for significant between-group differences., Results: Of 662 reported cases (median age = 36 years, male = 61.2%), 122 (18.4%) involved LAIs (second-generation antipsychotic [SGA] LAIs [SGA-LAIs] = 10, 1.5%), whereas 540 (81.6%) involved OAPs (SGA-OAPs = 159, 24.0%). The 2 groups did not differ in age, illness duration, comorbidities, or presence or severity of NMS symptoms (median Francis-Yacoub score: LAIs = 26 vs OAPs = 23, P = .8276). Antipsychotic formulation was not significantly associated with longer duration of hospitalization (LAIs = 5.0 weeks vs OAPs = 3.8 weeks, P = .8322), post-NMS sequelae (LAIs = 8.8% vs OAPs = 7.0%, P = .7489), or death (LAIs = 10.7% vs OAPs = 6.7%, P = .0861). When different, post hoc confounder-adjusted models were used, duration of NMS (but not hospitalization for NMS) was longer with LAIs than with OAPs (median = 2.6 vs 1.8 weeks, P = .0339), driven by FGAs rather than SGAs., Conclusions: These data, plus the fact that only 10 published NMS cases exist with SGA-LAIs, should mitigate safety concerns regarding LAIs, but results should be interpreted cautiously since they are based on case reports., (© Copyright 2020 Physicians Postgraduate Press, Inc.)

Objective: Although psychiatric disorders are associated with decreased health-related quality of life, it is unknown whether symptom remission is associated with its improvement or normalization., Method: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a large national sample of the United States population. A total of 34,653 adults 18 years and older residing in households completed 2 waves (2001-2002 and 2004-2005) of face-to-face surveys. DSM-IV psychiatric diagnoses of mood, anxiety, and substance use disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Health-related quality of life was assessed with the Short Form-12 Health Survey, Version 2 (SF-12)., Results: Remission from alcohol dependence, major depressive disorder, bipolar disorder, dysthymia, social anxiety disorder, and generalized anxiety disorder was associated with significant improvement in SF-12 scores compared to nonremission (ranging from β = 7.28 in dysthymia to β = 3.16 in social anxiety disorder, all P < .05). However, with the exception of alcohol abuse, individuals who had remitted from all other disorders had lower SF-12 scores than individuals without lifetime history of the disorder. Furthermore, remission of alcohol abuse, cannabis use disorder, nicotine dependence, panic disorder, and specific phobia was not associated with significant improvement in SF-12 scores., Conclusions: The relationship between psychiatric disorders and health-related quality of life is complex and differs across disorders. Although remission of several psychiatric disorders was associated with significant improvements, remission was generally not associated with full restoration of health-related quality of life, even among those without comorbid disorders., (© Copyright 2013 Physicians Postgraduate Press, Inc.)