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Long-acting risperidone and oral antipsychotics in unstable schizophrenia
Robert A Rosenheck1, John H Krystal, Robert Lew
1Veterans Affairs (VA) New England Mental Illness, Research Education and Clinical Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA. robert.rosenheck@va.gov
The New England Journal of Medicine
|March 4, 2011
Summary
Long-acting injectable risperidone did not significantly reduce hospitalizations for schizophrenia compared to oral antipsychotics. The injectable form also showed no improvement in symptoms or quality of life, with more side effects.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Trials
Background:
- Long-acting injectable risperidone, a second-generation antipsychotic, is proposed to enhance treatment adherence in schizophrenia.
- Previous research has not evaluated its long-term efficacy in patients with unstable disease through randomized trials.
Purpose of the Study:
- To assess the efficacy of long-acting injectable risperidone versus oral antipsychotics in patients with schizophrenia or schizoaffective disorder at high risk for hospitalization.
- To evaluate the impact on psychiatric symptoms, quality of life, and functioning.
Main Methods:
- A randomized trial involving 369 patients within the Veterans Affairs (VA) system.
- Participants received either long-acting injectable risperidone (25-50 mg every two weeks) or a psychiatrist's choice of oral antipsychotic.
- Follow-up was up to 2 years, with primary endpoint being psychiatric hospitalization.
Main Results:
- No significant difference in hospitalization rates between long-acting injectable risperidone (39%) and oral antipsychotics (45%).
- No significant improvements in psychiatric symptoms, quality of life, or global functioning were observed with the injectable form.
- Increased incidence of injection-site adverse events and extrapyramidal symptoms reported in the long-acting injectable risperidone group.
Conclusions:
- Long-acting injectable risperidone is not superior to oral antipsychotics for patients with schizophrenia or schizoaffective disorder requiring hospitalization or at high risk.
- The injectable formulation was associated with a higher rate of local injection-site reactions and extrapyramidal side effects.
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