Long-Acting Injectable Antipsychotics for First-Episode Schizophrenia: The Pros and Cons

Table 1

Overview of clinical studies on the effectiveness of long-acting injectable antipsychotics for the treatment of first-episode or recent-onset schizophrenia.

Study

No.of patients; (female/male)

No.of; previous; episodes

Duration of; illness

Study; duration

Design

Dosage

Reduction of total PANSS (%)

Reduction of; CGI-S (%)

Functional; improvement (%)

Tolerability

Adherence

Long-term; outcome

Parellada et al.[24]

382 (117/265)

ns

1.5 (1.1) yr

6 mo

Open, 1-arm, mc

25–50 mg

18.3%

ns

GAF; 13.4%

ESRS 53.8%↓; PRL-related 0.3%; wt gain 4%

ns

ns

Kim et al.[19]

RLAI: 22 (14/8); Oral: 28 (17/11)

1

1.5 (1.5) yr

2 yr

Open, C

25–50 mg

RLAI: 10.0%; Oral: 2.0%

RLAI: 10.0; Oral: 2.5

GAF; RLAI: 26.9%; Oral: 0.5%

ns

RLAI: GA (>70%) 68%; Oral: GA 32%

2-yr relapse; RLAI: 23%; Oral: 75%

Emsley et al.[26]

50 (18/32)

1

≤1 yr

2 yr

Open, 1-arm

25–50 mg

Remission: 45.0%; No remission: 29.7%

Remission: 73.1%; No remission: 34.4%

SOFAS; remission: 85.2%; No remission: 43.2%

ESRS 53.3%↓ in remission; 55.0%↑ in no remission

ns

2-yr remission; 62%

Emsley et al.[27]

RLAI: 50 (18/32); Oral: 47 (20/27)

≤2 adm

≤ 1yr

2 yr

Post hoc comparison; RLAI: Open, 1-arm; Oral: R, C (ris versus hal)

25–50 mg

RLAI: 44.0%; Oral: 28.8%

ns

ns

Total maximum changes of ESRS; RLAI: 1.40 (2.60); Oral: ris 5.61 (5.22); hal 9.04 (6.21)

ns

2-yr remission; RLAI: 64.0%; Oral: 40.4%

Weiden et al.[18]

RLAI: 19; Oral: 11

1

≤16 wk of lifetime AP exposure

12 wk

Open, R, C

25–37.5 mg

ns

ns

ns

ns

RLAI: 89%; Oral: 59%

ns

Napryeyenko et al.[28]

294 (116/178)

2.4 (0.7)

≤2 yr

26 wk

Open, 1-arm, mc

25–50 mg

18.6%

20.5%

GAF; 16.9%

EPS 5.6%; PRL-related 4.3%; wt gain 3.0%

NC, n = 3

1-yr remission; 59.5%

Dubois et al.[29]

105 (79/26)

<4

3.0 (3.92) yr

12 mo

Open, 1-arm, mc

25–50 mg

ns

43.4%

GAF; 71.1%

EPS 3.8%; PRL-related 9.5%; wt gain 18.1%

>80%

1-yr remission; 34.1%

PANSS: Positive and Negative Syndrome scale; CGI-S: Clinical Global Impression-Severity scale; GAF: Global Assessment of Functioning; SOFAS: Social Occupational Functioning Assessment scale; ESRS: Extrapyramidal Symptom Rating scale.adm: hospital admissions for psychosis; AP: antipsychotics; C: controlled study; EPS: extrapyramidal symptoms; GA: good adherence (>70%) group; hal: haloperidol; mc: multicenter; mo: month; NC: noncompliance; ns: not specified; open: open-label; oral: oral risperidone; PRL: prolactin; pts: patients; R: randomized; ris: risperidone; RLAI: long-acting injectable risperidone; wk: week; wt: weight; yr: year; 1-arm: single arm.