Discontinuation rates during long-term, second-generation antipsychotic long-acting injection treatment. A systematic review.

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Discontinuation rates during long-term, second-generation antipsychotic long-acting injection treatment. A systematic review.

Psychiatry Clin Neurosci. 2019 Jan 27;:

Authors: Gentile S

Abstract
AIM: Aim of this review is to analyze the discontinuation rates during long-term treatment with second-generation long-acting injection (SGA-LAIs) in adults with either schizophrenia-spectrum or bipolar disorders.
METHODS: A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (January 1, 2001-October 12, 2018) identified 1214 abstracts which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥ 36 weeks. Data were extracted from fifty-one articles meeting the inclusion criteria.
RESULTS: In all head-to head comparisons, and both studies on patients with schizophrenia-spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA-LAIs was, at best, similar than that recorded in patients treated with first-generation antipsychotics in either oral or LAI formulations or with oral SGAs. In particular, in most of SGA-LAI long-term studies, the rate of premature drop-out is higher than 50%.
CONCLUSIONS: Reviewed data suggest that SGA-LAIs show no clear superiority over less expensive drugs (including FGA-LAIs and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long-term pharmacological treatment regimens. This article is protected by copyright. All rights reserved.

PMID: 30687998 [PubMed - as supplied by publisher]