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Long-acting injectable antipsychotics (LAIAs) offer advantages...
Long-acting injectable antipsychotics (LAIAs) have been developed to improve the poor levels of adherence to oral antipsychotics observed in patients with schizophrenia and, consequently, to alleviate the high relapse and rehospitalization rates associated with nonadherence [1]. The efficacy of an individual second-generation LAIA formulation in treating schizophrenia tends to parallel that of the counterpart oral formulation, although some LAIA formulations may offer some slight advantages (Table 1). Of note, the benefits of LAIAs relative to oral antipsychotics are likely underestimated in randomized, controlled trials, as such trials underrepresent the nonadherent population and contain methodology-inherent compliance-improving factors [1]. Naturalistic trial designs are more likely to be representative of the population receiving LAIAs in clinical practice; such trials have demonstrated that LAIAs are more efficacious than oral antipsychotics in reducing rates of hospitalization [2, 3], an effect that may be particularly pronounced in first-episode patients [1, 4].
In general, the safety profiles of the second-generation LAIAs closely resemble those of their oral formulations (Table 1). One exception is the long-acting injectable formulation of olanzapine pamoate, which is associated with post-injection delirium sedation syndrome (Table 1). As with other antipsychotics, patients receiving LAIAs should be monitored for cardiovascular and metabolic changes, as well as for extrapyramidal symptoms [5].
This article presents a summary of the barriers to the use of LAIAs and possible approaches to overcome these barriers as reviewed by Parellada and Bioque [1].
...but are under-prescribed
Despite the potential advantages of LAIA formulations in the treatment of schizophrenia, LAIAs are not widely prescribed in clinical practice [1]. This is particularly true for patients early in the course of the disorder, at which stage the progression may be slowed with appropriate treatment [1]. While regional differences...