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Child Psychiatrist /Adult Psychiatrist

Long-Acting Injectable Antipsychotics Reduce 30-Day Rehospitalizations

Long-acting injectable (LAI) antipsychotics reduce 30-day rehospitalizations relative to oral antipsychotics, according to study results published in the Journal of Clinical Psychopharmacology. Hospital inpatient free trial programs were also found to aid in LAI antipsychotic acquisition.


Rehospitalizations

Prior literature has demonstrated the efficacy of LAI antipsychotics over oral formulations in diminishing the frequency of readmissions. However, there is limited evidence supporting the role of LAI antipsychotics in the prevention of rehospitalizations. To address this knowledge gap, investigators conducted a single-center retrospective cohort study to compare psychiatric readmission rates among patients with schizophrenia or schizoaffective disorder who were prescribed either LAI or oral antipsychotics upon discharge between August 1, 2019, and June 30, 2022. The study also evaluated the benefits of leveraging pharmaceutical free trial programs for LAI medications.


Screening a total of 1574 patients, researchers identified 343 individuals who were discharged with prescriptions for at least 1 oral or LAI antipsychotic. Within this cohort, 62.7% were diagnosed with schizophrenia and 37.3% with schizoaffective disorder. On average, patients were 40.3 years of age, 55.4% were male, and 32.9% were African American.


Patients discharged from an inpatient psychiatric unit on LAI medications had a statistically significant decrease in 30-day readmission rates as compared with patients discharged on oral antipsychotics.


In the study, 30% of patients were discharged on an LAI antipsychotic, while 70% were on oral antipsychotics. The LAI antipsychotic prescriptions included aripiprazole lauroxil (45.6%), haloperidol decanoate (35%), paliperidone palmitate (15.5%), extended-release aripiprazole injection (2.9%), fluphenazine decanoate (1%), and risperidone long-acting injection (1%). Among patients discharged on oral antipsychotics, the majority were prescribed risperidone (27.5%) or olanzapine (21.3%). The investigators also found that the average chlorpromazine equivalent dose was higher for the LAI group (477.3 mg/d) compared with the oral group (278.6 mg/d, P <.001). Additionally, 64% of LAI antipsychotics were accessed through hospital inpatient free trial programs.


The investigators observed a 6.4% readmission rate for schizophrenic or schizoaffective exacerbation within 30 days following discharge. Patients on a LAI antipsychotic had a significantly lower rate of readmission at 1.9% compared with 8.3% for the oral antipsychotic group (P =.03; 95% CI, 1.05–20.02). Of those readmitted, 43% were diagnosed with schizophrenia and 57% with schizoaffective disorder.


The researchers concluded, “Patients discharged from an inpatient psychiatric unit on LAI medications had a statistically significant decrease in 30-day readmission rates as compared with patients discharged on oral antipsychotics.”


Study limitations include the retrospective study design, small sample size, and incomplete accounting of patient history and admissions to other facilities.


Note: This article originally appeared on Psychiatry Advisor

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