Long-acting injectables (LAIs) are thought to have a number of advantages over oral antipsychotics (APs), including removing the need for daily administration, improving adherence, and enhancing patient outcomes.¹ However, LAIs remain underutilized relative to oral APs, with one analysis of commercially insured patients finding that oral APs represent 68.1% of prescriptions, compared with 4.6% for LAIs.² 

At the American Psychiatric Association Annual Meeting in 2022, Dr. Christoph Correll (Professor of Psychiatry at the Zucker School of Medicine at Hofstra/Northwell, New York, and Professor and Chair of the Department of Child and Adolescent Psychiatry, Charité University Medicine, Berlin) discussed the factors that influence physicians’ views on LAIs, and explored data from research on patient attitudes to LAIs.

Before patients are initiated on LAI therapy, over half receive at least two different oral APs.³ However, when LAI therapy is initiated, 86% remain on that LAI successfully, with only 13% moving to a second LAI.³ 

Listen to Dr. Corell discuss how LAIs have been underutilized in the US:

Factors deterring physicians from prescribing LAIs

In a survey of physicians, the top factors that prevented them from prescribing LAIs were cost, lack of regular availability, concern over serious adverse events, such as neuroleptic malignant syndrome or extrapyramidal symptoms, and patients being scared of using an injectable medication.⁴ Over half believed they underuse LAIs to a certain extent, and nearly 20% thought they definitely, or to a large extent, underuse LAIs.⁴

Listen to Dr. Correll describe physicians’ beliefs around their underuse of LAIs:

Physicians’ beliefs around patient concerns regarding LAIs

Physicians may believe that patients do not wish to be treated with an LAI. Reasons commonly proposed include perceived stigma, embarrassment, reduced autonomy, a feeling of being controlled, loss of ability to control when medication is taken, observation time at the clinic, a feeling of being bound to the clinic, and injection-site pain.⁵ In a study comparing the responses of 63 health professionals and 101 patients on oral APs, who were asked to grade the effect of each of these factors on a scale from 0 (does not affect at all) to 100 (decisive in declining LAIs), the actual fears of patients were lower for each factor, except for being tied to a clinic and loss of ability to decide when to take medication.⁵

Furthermore, among patients with experience of being treated with an LAI, the actual fear fell numerically for each factor, and significantly so with respect to being tied to a clinic (P=0.018) and loss of ability to decide when to take medication (P=0.001) compared with patients on oral APs.⁵

Listen to Dr. Correll discuss a study demonstrating actual patient attitudes to LAIs:

Training clinical staff may increase utilization of LAIs. In one clinical study in particlular, staff were educated on the benefits of LAIs and trained in strategies to improve communication and overcome logistical barriers. After this, 91% of patients accepted at least one LAI during their first 3 months in the study.⁶ 

In summary, it is a myth that patients do not want or will not accept treatment with LAIs, and you can understand why this myth persists by viewing the full presentations at APA 2022 here To download Dr. Correll’s presentation slides, visit: https://uscnsb.tevapharm.com/scope-engage/

References

1. Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol 2014;4:198–219.
2. Kane JM, Mychaskiw MA, Lim S, et al. Prevalence of oral and long-acting injectable antipsychotic use among patients with schizophrenia in the United States: an analysis of a commercial claims database. Presented at: 34th European College of Neuropsychopharmacology (ECNP) Congress; October 2–5, 2021; Lisbon, Portugal. P.0760.
3. Kane JM, Mychaskiw MA, Lim S, et al. Treatment patterns among patients in the United States utilizing long-acting injectable antipsychotic agents: an analysis of a commercial claims database. Presented at: Psych Congress 2021; October 29–November 1, 2021; San Antonio, Texas.
4. Grover S, Sahoo S, Mehra A. Perceptions of psychiatrists toward the use of long-acting injectable antipsychotics. J Clin Psychopharm 2019;39:611–9.
5. Cahling L, Berntsson A, Bröms G, Öhrmalm L. Perceptions and knowledge of antipsychotics among mental health professionals and patients. BJPsych Bull 2017;41:254–9.
6. Kane JM, Schooler NR, Marcy P, et al. Patients with early-phase schizophrenia will accept treatment with sustained-release medication (long-acting injectable antipsychotics): results from the recruitment phase of the PRELAPSE trial. J Clin Psychiatry 2019;80:18m12546.

Dr. Correll’s full APA presentation: NPS-US-NP-01073

NPS-US-NP-01128