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Use and Discontinuation Rates of Long-Acting Injectable Antipsychotics Between Race/Ethnicity in Older Adults Using
Christopher M Cassara1, Jianing Xu2, Daniel B Hall3
1College of Pharmacy, University of Georgia, Athens, Georgia, USA.
Journal of the American Geriatrics Society
|February 5, 2025
Summary
First-generation long-acting injectable antipsychotics were discontinued earlier than second-generation agents in older adults. Black patients received first-generation agents more often, potentially impacting health outcomes.
Area of Science:
- Psychiatry
- Geriatrics
- Pharmacology
Background:
- Long-acting injectable (LAI) antipsychotics are crucial for managing schizophrenia spectrum disorders.
- Understanding prescribing patterns and discontinuation rates in older adults is essential for optimizing treatment.
Purpose of the Study:
- To analyze the prescribing patterns of LAI antipsychotics in patients aged 65 and older.
- To compare discontinuation rates between different LAI agents and examine racial/ethnic disparities.
Main Methods:
- Utilized Merative MarketScan Medicaid Databases (2017-2021) for patients 65+ prescribed LAI antipsychotics.
- Employed logistic and Cox proportional hazard regression to analyze race/ethnicity, LAI generation, and discontinuation rates.
Main Results:
- Paliperidone palmitate (1-month), haloperidol decanoate, and risperidone microspheres were most common LAIs.
- Black patients received first-generation LAIs more frequently than White patients (OR: 1.74).
- First-generation LAIs demonstrated significantly earlier discontinuation rates compared to second-generation LAIs (HR: 2.12).
Conclusions:
- First-generation LAI antipsychotics are associated with earlier treatment discontinuation than second-generation agents.
- Disparities in prescribing LAI antipsychotics between Black and White older adults were observed, warranting further investigation into potential health outcome impacts.
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