Baseline results from the European non-interventional Antipsychotic Long acTing injection in schizOphrenia (ALTO) study

Eur Psychiatry. 2018 Aug;52:85-94. doi: 10.1016/j.eurpsy.2018.04.004. Epub 2018 May 4.


Background: The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs.

Methods: Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life.

Results: For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight.

Conclusions: These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.

Keywords: Antipsychotic agents; Long-acting injectable; Medication adherence; Prescriptions; Schizophrenia.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / classification
  • Antipsychotic Agents / therapeutic use*
  • Delayed-Action Preparations / therapeutic use
  • Europe
  • Female
  • Humans
  • Injections, Intramuscular
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Quality of Life / psychology*
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenic Psychology*


  • Antipsychotic Agents
  • Delayed-Action Preparations