Concurrent Oral Antipsychotic Drug Use Among Schizophrenia Patients Initiated on Long-Acting Injectable...

Area of Science:

• Psychiatry
• Clinical Pharmacology
• Health Services Research

Background:

• Pharmacological treatment is key for schizophrenia management, with oral antipsychotics and long-acting injectables (LAIs) being common options.
• LAIs are recommended for nonadherent patients, but concurrent oral antipsychotic use alongside LAIs is not well-documented.
• Schizophrenia treatment often involves multiple antipsychotic medications, raising questions about optimal prescribing strategies.

Purpose of the Study:

• To investigate the prevalence and duration of concurrent oral antipsychotic prescriptions in patients initiating long-acting injectable (LAI) therapy.
• To analyze prescribing patterns based on LAI generation (first-generation vs. second-generation) and specific agents.
• To understand the extent of medication overlap in schizophrenia treatment.

Main Methods:

• An observational, claims-based study of 340 Medicaid patients with schizophrenia.
• Inclusion criteria: recent nonadherence and hospitalization, initiation of LAI therapy (first-generation or second-generation).
• Analysis of concurrent oral antipsychotic prescription frequency and duration in the 6 months post-hospital discharge.

Main Results:

• 75.9% of patients initiated on LAIs received a concurrent oral antipsychotic prescription post-hospital discharge.
• Concurrent prescribing rates varied by LAI: paliperidone palmitate (58.8%) to LAI risperidone (88.9%).
• Overlap often lasted over 30 days and covered 50% or more of the LAI treatment duration.

Conclusions:

• Concurrent oral antipsychotic prescribing is highly prevalent in patients receiving LAIs for schizophrenia.
• The duration of this overlap suggests potential for polypharmacy beyond guideline recommendations.
• Further research is needed to understand the reasons for these prescribing patterns and to define optimal antipsychotic treatment strategies.