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Clinical guideline recommendations for antipsychotic long-acting injections

  • John M. Kane (a1) and Carlos Garcia-Ribera (a2)
Abstract
Background

Long-acting injections (LAIs) of antipsychotic drugs were developed over 40 years ago in an attempt to improve the long-term treatment of schizophrenia.

Aims

To review existing guidelines concerning antipsychotic use generally, and LAIs in particular, and how patients might be identified as potential candidates for LAI treatment.

Method

Literature review.

Results

Currently several first-generation and one second-generation antipsychotic LAIs are available, with others under development. Although the use of LAIs is widespread around the world, patterns of use vary widely. Important considerations regarding the use of LAIs include the indications for long-term pharmacotherapy in schizophrenia in general, the indications for LAIs, the risks associated with LAIs, the need to update guidelines and the issue of cost.

Conclusions

The use of these injections in first-episode psychosis and treatment-refractory schizophrenia is not currently a focus of recommendations, but should be considered. Long-acting injections remain an underutilised option in many countries despite frequent non-adherence with oral medication and subsequent relapse.

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Copyright
Corresponding author
Dr John M. Kane, Department of Psychiatry, Zucker Hillside Hospital, 75–59 263 Street, Glen Oaks, NY 11004, USA. Email: psychiatry@lij.edu
Footnotes
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Declaration of interest

J.K. has been a consultant to or member of an advisory board for Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Janssen, Johnson & Johnson, Lundbeck, Otsuka, Pfizer, PGxHealth, Proteus, Vanda and Wyeth; he is a member of the speakers bureau for AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen-Cilag. C.G.R. has been a consultant to AstraZeneca, Bristol-Myers Squibb, Otsuka and Sanofi-Synthelabo; he has been a speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Novartis, Otsuka and Sanofi-Synthelabo.

Footnotes
References
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1 Kane, JM, Aguglia, E, Altamura, AC, Ayuso-Gutierrez, JL, Brunello, N, Fleischhacker, WW, et al. Guidelines for depot antipsychotic treatment in schizophrenia. Eur Neuropsychopharmacol 1998; 8: 5566.
2 Kane, JM, Quitkin, F, Rifkin, A, Ramos-Lorenzi, JR, Nayak, DV. Fluphenazine versus placebo in patients with remitted acute first episode schizophrenia. Arch Gen Psychiatry 1982; 39: 70–3.
3 Crow, TJ, MacMillan, JF, Johnson, AL, Johnstone, EC. A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 1986; 148: 120–7.
4 Robinson, DG, Woerner, MG, Delman, HM, Kane, JM. Pharmacological treatments for first-episode schizophrenia. Schizophr Bull 2005; 31: 705–22.
5 Robinson, DG, Woerner, MG, Alvir, JMJ, Geisler, S, Koreen, A, Sheitman, B, et al. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 1999; 156: 544–9.
6 Harding, CM, Zubin, J, Strauss, JS. Chronicity in schizophrenia: revisited. Br J Psychiatry 1992; 161 (suppl 18): 2737.
7 Harrow, M, Jobe, TH. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15 year multifollow-up study. J Nerv Ment Dis 2007; 195: 406–14.
8 Kane, JM, Woerner, M, Weinhold, P, Wegner, J, Kinon, B. A prospective study of tardive dyskinesia development: preliminary results. J Clin Psychopharmacol 1982; 2: 345–9.
9 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. J Clin Psychiatry 2004; 65: 267–73.
10 Lehman, AF, Steinwachs, DM, Survey Co-Investigators of the PORT Project. Patterns of usual care for schizophrenia. Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophr Bull 1998; 24: 1120.
11 National Institute for Health and Clinical Excellence. Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell/British Psychological Society, 2003.
12 American Psychiatric Association Work Group on Schizophrenia. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161 (2 suppl): 156.
13 Canadian Psychiatric Association. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry 2005; 50 (suppl 1): 7S56S.
14 Moore, TA, Buchanan, RW, Buckley, PF, Chiles, JA, Conley, RR, Crismon, ML, et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2006 update. J Clin Psychiatry 2007; 68: 1751–62.
15 Miller, AL, Hall, CS, Buchanan, RW, Buckley, PF, Chiles, JA, Conley, RR, et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry 2004; 65: 500–8.
16 Argo, TR, Crismon, ML, Miller, AL, Moore, TA, Bendele, SD, Suehs, B. Texas Medication Algorithm Project Procedural Manual. Schizophrenia Treatment Algorithm. Texas Department of State Health Services, 2008.
17 Fenton, WS, Blyler, CR, Heinssen, RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull 1997; 23: 637–51.
18 Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002; 63: 892907.
19 Velligan, DI, Lam, F, Ereshefsky, L, Miller, AL. Psychopharmacology: perspectives on medication adherence and atypical antipsychotic medications. Psychiatr Serv 2003; 54: 665–7.
20 Velligan, DI, Wang, M, Diamond, P, Glahn, DC, Castillo, D, Bendle, S, et al. Relationships among subjective and objective measures of adherence to oral antipsychotic medications. Psychiatr Serv 2007; 58: 1187–92.
21 Kane, JM, Rifkin, A, Quitkin, F, Nayak, D, Ramos-Lorenzi, J, Klein, DF, et al. Low dose fluphenazine decanoate in maintenance treatment of schizophrenia. Psychiatry Res 1979; 1: 341–8.
22 Kane, JM, Rifkin, A, Woerner, M, Reardon, G, Sarantakos, S, Schiebel, D, et al. Low-dose neuroleptic treatment of outpatient schizophrenics: I. Preliminary results for relapse rates. Arch Gen Psychiatry 1983; 40: 893–6.
23 Schooler, NR, Keith, SJ, Severe, JB, Matthews, SM, Bellack, AS, Glick, ID, et al. Relapse and rehospitalization during maintenance treatment of schizophrenia. Arch Gen Psychiatry 1997; 54: 453–63.
24 Waddell, L, Taylor, M. Attitudes of patients and mental health staff to antipsychotic long-acting injections: systematic review. Br J Psychiatry 2009; 195 (suppl 52): s4350.
25 Gray, R, Spilling, R, Burgess, D, Newey, T. Long-acting injections in clinical practice: medication management and patient choice. Br J Psychiatry 2009; 195 (suppl 52): s516.
26 Emsley, R, Medori, R, Koen, L, Oosthuizen, PP, Niehaus, D, Rabinowitz, J. Long-acting injectable risperidone in the treatment of subjects with recent-onset psychosis. J Clin Psychopharm 2008; 28: 210–3.
27 Weiden, PJ, Schooler, NR, Weedon, JC, Elmouchtari, A, Sunakawa, A, Goldfinger, SM. Long-acting injectable risperidone vs. continuing on oral atypical antipsychotic for first-episode schizophrenia patients: initial adherence outcomes. J Clin Psychiatry in press.
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Clinical guideline recommendations for antipsychotic long-acting injections

  • John M. Kane (a1) and Carlos Garcia-Ribera (a2)
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