In a recent publication in the journal Schizophrenia, researchers conducted an observational mirror-image study (STAR Network Depot Study) that included 261 LAI-naïve participants aged at least 18 years between 2015 and 2018.

The researchers recruited individuals prescribed an LAI antipsychotic over a period of 12 months and conducted evaluations after 6 and 12 months. Eligible criteria for participants included those who were 1) 18 years old or older; 2) prepared to sign the informed consent; 3) starting an LAI medication; and 4) with no LAI use over the previous 3 months.

The authors indicated that the simultaneous prescription of other medications, including oral antipsychotics, was not an exclusion criterion and included patients from various healthcare settings, from outpatients, hospital psychiatric wards, daytime community centers, and residential facilities.

The study population included participants with an average age of 41.4 ± 13.4 years (41% women, 87.7% Italian) who were diagnosed with schizophrenia spectrum disorders (71.3%) and other personality disorders followed under real-world clinical practice.

The researchers compared multiple clinical outcomes, including the utilization of psychotropic medications, adherence/attitude, psychopathology, hospitalization, and adverse events 1 year before and after the first injectable LAI was administered in unselected patients with severe mental illness.

According to the study, 10% of participants had disease onset before age 18 years, and 49.4% had onset between ages 18 and 30 years. Most participants, representing 56.7%, were diagnosed at least 6 years before recruitment. The authors revealed low levels of social support and social/working functioning, with 52.9% of participants living with parents/relatives, 3.8% living in residential homes, only 14.2% married, and 53.6% unemployed.

The results indicated that of the 186 participants with schizophrenia-spectrum disorders, 29.5% discontinued the LAI before 1 year. Based on their results, the authors indicated that at baseline, a shorter illness duration and lower attitude and adherence scores were observed in LAI discontinuers.

They wrote, “The mirror-image analysis showed reduced hospital admissions only for LAI continuers. Over time, continuers spent less days hospitalized but had more adverse events and more antipsychotics prescribed, with higher overall doses.”

The authors also noted that their data further support the idea that LAI formulations, compared with oral antipsychotics, may provide additional clinical benefits to patients with severe mental illness, while the risk of discontinuing the LAI over time should not be discounted.

“This study shows that LAIs might be beneficial in unselected patient populations, provided that adherence is maintained. LAI continuers spent less time hospitalized but received more antipsychotics and suffered from more cumulative adverse events over time. Therefore, the choice of initiating and maintaining an LAI should be carefully weighed on a case-by-case basis,” the authors concluded.

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