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Risperidone long-acting injection: the first 50 patients

  • Carol Paton (a1) and Chike Okocha (a2)
Abstract
Aims and Method

Risperidone long-acting injection (RLAI) is the first atypical antipsychotic drug to be available in a ‘depot’ formulation. The evidence base underpinning its use is small. We sought to evaluate its early use in clinical practice by a naturalistic follow-up study of the first 50 patients to be prescribed RLAI in one National Health Service Trust.

Results

At 6 months, 54% of patients had achieved at least minimal improvement, 4% were unchanged, 24% failed to comply, and 18% fared poorly and were switched to alternative antipsychotics. The attrition rate at 6 months was 42%. Supplementation with oral antipsychotics was often required for longer than 3 weeks. Only half of those who had a good clinical outcome at 6 months had achieved this by 3 months.

Clinical Implications

Some patients responded well to RLAI, but the overall attrition rate was high. Although RLAI provides additional choice in the range of treatments available for people with schizophrenia, we have much to learn about how to optimise its use in practice.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Kane, J. M., Eerdekens, M., Lindenmayer, J. P., et al (2003) Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. American Journal of Psychiatry, 160, 11251132.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Risperidone long-acting injection: the first 50 patients

  • Carol Paton (a1) and Chike Okocha (a2)
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eLetters

Letter to the Editor, Psychiatric Bulletin

ROBERT LASSER, PHYSICIAN
05 April 2004

Letter to the Editor, Psychiatric Bulletin Paton C & Okocha C. (2004) Risperidone long-acting injection: the first 50 patients. 28, 2-24.

Dear Editor,

We were pleased to read of the positive experience with long-acting risperidone by Paton & Okocha. The abstract, however, appeared inconsistent with the data describing generally positive patient outcomes.From the abstract alone, the findings with long-acting risperidone sound more negative than they actually were.

Specifically, the authors studied a difficult-to-treat population (42of 50 patients with histories of non-compliance or unacceptable EPS). Even in this population, a majority (54%) had at least minimal improvement, with 40% (20 of 50 patients) being seen as 'much or very muchimproved'. This is impressive considering the population examined, but theauthors do not mention this context when drawing their conclusions.

Further, one might view a 40% attrition rate to be a positive outcomegiven that patients were selected largely on the basis of noncompliance. Comparison to a published one-year trial1 may not be entirely appropriate as patients in the latter were selected on the basis of clinical stability, not noncompliance, and most were switched from oral atypical, not depot, antipsychotics.

We agree with Paton & Okocha about the need for additional information regarding long-acting risperidone, including mention that at least six months of therapy are needed before assessing outcome. However, we interpret their findings as supportive of the potential for further improvements among more severely ill or difficult to treat patients, complimenting the 'average' patients studied by Fleischhacker et al.1 Hopefully, readers will consider the full report before reaching conclusions about the potential impact of long-acting risperidone for their particular patients.

John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, NY Robert Lasser, MD, Janssen Medical Affairs, LLC, Titusville, NJ Edward Crumbley, MS, Janssen Medical Affairs, LLC, Titusville, NJ

References

1. FLEISCHHACKER W.W., EERDEKENS M, KARCHER K, et al. (2003) Treatment of schizophrenia with long-acting injectable risperidone: a 12-month open-label trial of the first long-acting second-generation antipsychotic. Journal of Clinical Psychiatry, 64, 10, 1250-1257.
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Conflict of interest: None Declared

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