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. 2022 Jul 1;5(7):e2224163.
doi: 10.1001/jamanetworkopen.2022.24163.

Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia

Yue Wei  1 , Vincent K C Yan  1 , Wei Kang  1 , Ian C K Wong  1   2   3 , David J Castle  4   5 , Le Gao  1 , Celine S L Chui  2   6   7 , Kenneth K C Man  1   2   3 , Joseph F Hayes  8 , Wing Chung Chang  9   10 , Esther W Chan  1   2   11
Affiliations

Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia

Yue Wei et al. JAMA Netw Open. .

Abstract

Importance: Evidence for improved clinical outcomes with long-acting injectable antipsychotics (LAIAs) vs oral antipsychotics (OAs) is limited in Asian populations and special patient groups, including older people (>65 years), people with substance use, and early initiators of LAIAs.

Objective: To compare the risk of disease relapse, health care use, and adverse events associated with the use of LAIAs vs OAs among people in Hong Kong with schizophrenia.

Design, setting, and participants: In this self-controlled case series study, individuals with a diagnosis of schizophrenia who were prescribed LAIAs and OAs between January 1, 2004, and December 31, 2019, were identified from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Data analysis was conducted from May to August in 2021.

Exposures: Use of LAIAs vs OAs.

Main outcomes and measures: Risk of disease relapse (hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and suicide attempts), health care use (all-cause emergency department visits and hospitalizations), and adverse events (hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms) between the period in which patients were treated with LAIAs and the period in which patients were treated with OAs were compared using Poisson regression.

Results: Of the 70 396 individuals with schizophrenia (37 200 women [52.8%]; mean [SD] age, 44.2 [15.8] years), 23 719 (33.7%) were prescribed both LAIAs and OAs. Compared with OAs, LAIAs were associated with a lower risk of hospitalizations for any cause (n = 20 973; incidence rate ratio [IRR], 0.63 [95% CI, 0.61-0.65]), hospitalizations for psychiatric disorders (n = 19 283; IRR, 0.52 [95% CI, 0.50-0.53]), hospitalizations for schizophrenia (n = 18 385; IRR, 0.53 [95% CI, 0.51-0.55]), and incident suicide attempts (n = 1453; IRR, 0.56 [95% CI, 0.44-0.71]). During full treatment with LAIAs, there was a reduction in hospitalizations for somatic disorders (n = 15 396; IRR, 0.88 [95% CI, 0.85-0.91]), hospitalizations for cardiovascular diseases (n = 3710; IRR, 0.88 [95% CI, 0.81-0.96]), and extrapyramidal symptoms (n = 22 182; IRR, 0.86 [95% CI, 0.82-0.91]) compared with full treatment with OAs. No significant difference was found for emergency department visits. Similar associations were observed during the subsequent treatment periods (beyond 90 days) and among older people and those with substance use, except for an increased risk of extrapyramidal symptoms among older people when initiating LAIAs (first 90 days). Compared with late initiators, early LAIA initiators had a greater reduction in these outcome events.

Conclusions and relevance: This self-controlled case series study of people in Hong Kong with schizophrenia suggests that LAIAs were associated with a lower risk of disease relapse and hospitalization than OAs, without an increased risk of adverse events. Clinicians should more broadly consider the long-term use of LAIAs for Chinese people with schizophrenia, especially early in the course of illness.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Wong reported receiving research funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the Hong Kong Innovation and Technology Commission, the National Institute for Health and Care Research, the European Commission, and the Australian National Health and Medical Research Council; and receiving expert testimony payment from the Hong Kong Court of Final Appeal outside the submitted work. Dr Castle reported receiving personal fees from Seqirus, Lundbeck, and Servier; and grants from Boeringer Ingelheim outside the submitted work. Dr Chui reported receiving grants from the Food and Health Bureau of the Government of the Hong Kong SAR during the conduct of the study; and grants from Hong Kong Innovation and Technology Commission, Hong Kong Research Grants Council, Pfizer, Amgen, and IQVIA outside the submitted work. Dr Man reported receiving grants from the CW Maplethorpe Fellowship, the European Union Horizon 2020, the National Institute for Health and Care Research, the Innovation and Technology Commission of the Government of Hong Kong SAR, and the Hong Kong Research Grant Council; and personal fees from IQVIA Ltd outside the submitted work. Dr Hayes reported receiving grants from UK Research and Innovation, Wellcome Trust, National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, and National Institute for Health and Care Research Applied Research Collaboration North Thames during the conduct of the study; and personal fees from Wellcome Trust and juli Health outside the submitted work. Dr Chan reported receiving grants from the National Natural Science Foundation of China during the conduct of the study; nonfinancial support from Wellcome Trust; grants from Research Grants Council (RGC, HKSAR), Research Fund Secretariat of the Food and Health Bureau (Health and Medical Research Fund [HMRF], HKSAR), National Health and Medical Research Council (Australia), Narcotics Division of the Security Bureau of HKSAR, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Janssen, Pfizer, Takeda, and Novartis; and personal fees from Pfizer, Novartis, and the Hong Kong SAR Hospital Authority outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Illustration of Self-controlled Case Series Study of the Use of Long-Acting Injectable Antipsychotics (LAIAs) vs Oral Antipsychotics (OAs)
Only 2 examples of the potential sequence of the medication regimen received are highlighted, for illustration purposes.
Figure 2.
Figure 2.. Subgroup Analyses for the Use of Long-Acting Injectable Antipsychotics (LAIAs) vs Oral Antipsychotics (OAs) During the Full Treatment Period
The incidence rate ratio (IRR) estimation was adjusted for age (1-year bands) and season (cut by the first date of March, May, September, and November).
See this image and copyright information in PMC

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