Attitude and perceptions of patients towards long acting depot injections (LAIs)

Attitude and influencing factors of patients with schizophrenia toward long-acting injections: A community-based cross-sectional investigation in China

Background

Low prescription rates of antipsychotic long-acting injections (LAIs) may be a major challenge in the prevention and treatment of schizophrenia. However, there are few studies on the usage and attitude toward LAIs among community-based patients with schizophrenia.

Methods

A large community-based cross-sectional investigation was conducted among 6,336 patients with schizophrenia from Shanghai, China from March 1 to June 30, 2021. The structured Attitude and Status toward Treatment of Community Patients with Schizophrenia Questionnaire (AST-CSQ) was used to investigate the attitude and influencing factors of community-dwelling patients with schizophrenia toward LAIs.

Results

Among the 6,336 participants, the average age was 49.28 ± 11.23. The rate of agreement to LAI antipsychotics among participants was 3.16% (n = 200). The family financial resources, care ability, and disease course of the LAIs group were less than those of the non-LAIs group. However, the LAIs group had higher immediate family guardianship, social activity, previous hospitalization, number of hospitalization, outpatient adherence, previous antipsychotic use, antipsychotic adherence, and attitude toward oral antipsychotics than the non-LAIs group, with significant differences between the two groups (p < 0.05). Furthermore, age (β = -0.036, OR 0.964, 95% CI 0.947-0.982), marital status (β = 0.237, OR 1.267, 95% CI 1.002-1.602), care ability (β = 0.709, OR 2.032, 95% CI 1.437-2.875), outpatient adherence (β = -0.674, OR 0.510, 95% CI 0.358-0.725), antipsychotic adherence (β = 0.920, OR 2.509, 95% CI 1.092-5.764), and attitude toward oral antipsychotics (β = -1.357, OR 0.258, 95% CI 0.103-0.646) were significant predictors of attitude toward LAI antipsychotics (p < 0.05).

Conclusions

The community-dwelling patients with schizophrenia in China had a low willingness to use LAIs. Patients of a younger age, more hospitalizations, and a shorter course of disease were prone to be more willing to accept LAIs. The patients' age, marital status, care ability, outpatient adherence, antipsychotic adherence, and attitude toward oral antipsychotics were important predictor of patients' attitudes toward LAIs. Under the global deinstitutionalized management model of mental disorders, these results highlight an urgent problems for public mental health service providers and policy-makers and provide more solutions for them.

Attitudes and perceptions about the use of long-acting injectable antipsychotics among behavioral health practitioners

Introduction

Long-acting injectable antipsychotics (LAI-As) are important tools for the treatment of schizophrenia, yet they appear to be underutilized. This study will assess practitioner perceptions of LAI-As to elucidate reasons for underuse and uncover new avenues to increase appropriate use.

Methods

An anonymous electronic survey was developed and actively distributed to behavioral health care practitioners (MD, DO, PA, NP, PharmD, RN, LCSW). Independent t testing and linear regression analysis was used to assess for interactions between survey responses and individual factors.

Results

A total of 146 survey responses were collected from September 3, 2020 to March 17, 2021. On average, participants thought that LAI-As were slightly underutilized in practice. The mean estimated patient acceptance rate for LAI-A therapy was 38.6% ± 29.5% (range = 0%-100%). Participants who were <40 years of age and those with a psychiatric pharmacist at their practice site had significantly higher estimated acceptance rates. The highest-rated barriers to LAI-A use were related to negative patient attitudes, lack of patient education, and access issues (eg, transportation, cost). Respondent characteristics including age, gender identity, geographic location, practice setting, and the presence of a psychiatric pharmacist significantly influenced the perceived impact of these barriers.

Discussion

Behavioral health practitioners generally believed that LAI-As were underused, and only one-third of their patients would be accepting of the therapy. Several barriers were perceived as frequently impacting LAI-A use, but these were reduced by the presence of a psychiatric pharmacist. Understanding practitioner perceptions can assist with increasing the use of LAI-As.

Efficacy of long-acting injectable versus oral antipsychotic drugs in early psychosis: A systematic review and meta-analysis

AIM

Long-acting injectable antipsychotic drugs (LAIs) are often used as an alternative to oral antipsychotics (OAPs) in individuals with psychosis who demonstrate poor medication adherence. Previous meta-analyses have found mixed results on the efficacy of LAIs, compared to OAPs, in patients with psychotic disorders. The objective of this meta-analysis was to compare the effectiveness of using LAIs versus OAPs in the early stages of psychosis.

METHODS

Major electronic databases were used to search for any studies examining the comparative effectiveness (i.e., relapse, adherence, hospitalization, and all-cause discontinuation) of any LAIs versus OAPs in early stages of psychosis. Studies published up to 6 June, 2019 were included and no language restriction was applied. Inclusion criteria were a diagnosis of schizophrenia or related disorder, where patients were in their first episode or had a duration of illness ≤5 years. Data were analysed using a random-effects model.

RESULTS

Fifteen studies (n = 10 584) were included, of which were 7 RCTs, 7 observational studies, and 1 post-hoc analysis. We found that LAIs provided advantages over OAPs in terms of relapse rates. No significant differences were found between LAI and OAP groups in terms of all-cause discontinuation, hospitalization, and adherence rates. However, considering only RCTs revealed advantages of LAIs over OAPs in terms of hospitalization rates.

CONCLUSIONS

LAIs may provide benefits over OAPs with respect to reducing relapse and hospitalization rates in early psychosis patients. There is a need for larger and better-designed studies comparing OAPs and LAIs specifically in early psychosis patients.

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network "Depot Study" was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions-conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently-showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders.

Attitudes and Willingness to Accept Long-Acting Injections for Patients With Schizophrenia in Beijing: A Cross-Sectional Investigation Based on Samples From the Communities

Background: Schizophrenia has brought a serious disease burden to China. Under the background that community rehabilitation has become the mainstream treatment model, the long-acting injection (LAI) can better prevent recurrence. Some districts in Beijing have also issued policies. This article aims to find out patient's current attitudes toward LAI and provide policy suggestions.

Methods: Some patients with schizophrenia in the communities are selected, while the survey format is face-to-face conversation. The content of the self-made questionnaire includes patients' willingness and reasons for accepting LAI treatment. Descriptive statistics, t-test and F-test are used to process the data from questionnaire surveys.

Results: About 10% of respondents have had experience using LAI and the current utilization rate is 2.4%. Respondents' willingness to accept LAI is generally low (only 18.1% are willing). The main reason for willingness is no need to take medication every day, while the main reasons for unwillingness are high cost, fear of injection and lack of understanding.

Conclusion: Beijing community patients are not very optimistic about LAI's cognition and willingness. Medication habits play an important role in their medication selection decisions. Intervention such as educate clinicians and patients about LAI and provide free injections to patients can be imposed. The promotion of LAI still has a long way to go.

The use of first-generation long-acting injectable antipsychotics in children and adolescents-A retrospective audit from India

OBJECTIVES

There is a dearth of knowledge regarding the usage of first-generation long-acting injectable (LAI) antipsychotics in children and adolescents, despite their off-label use, in low and middle-income countries (LAMIC).

METHODS

Case records of subjects less than 18 years of age who received any first-generation LAI antipsychotics in the last 10 years(between 2010-19) were reviewed. Details documented for the study from the records included ICD-10 diagnoses, clinical profile, indication for use, medication details, severity of illness, improvement, and global functioning.

RESULTS

Forty-five subjects (55.3 % male) received first-generation LAI antipsychotics during the study period. All subjects were diagnosed to have serious mental illnesses, with Schizophrenia (52.6 %) and Bipolar Affective Disorder (31.6 %) being the most common diagnoses. At baseline, according to Clinical Global Impressions-Severity (CGI-S) scale, a majority (94.7 %) were severely or markedly ill. Fluphenazine decanoate (60.5 %), flupenthixol decanoate (34.2 %), and zuclopenthixol decanoate (18.4 %) were the first- generation LAI antipsychotics used. Nearly half the subjects (47.4 %) experienced at least one acute adverse event. The most common acute adverse events noted included tremors, rigidity, sialorrhea, and bradykinesia. 31/34 subjects showed improvement at follow-up.

CONCLUSIONS

The profile of patients for whom first-generation LAI antipsychotics were used included children and adolescents who had severe mental illnesses and were considerably ill. Acute adverse events were common. Short and- long-term follow-up studies are needed to evaluate the efficacy and safety of first-generation LAI antipsychotics in children and adolescents, especially in low and middle-income countries, given that they are reasonably priced and efficacious for severe mental illnesses.

Asenapine Transdermal Patch for the Management of Schizophrenia

Purpose of Review

This is a comprehensive review of the literature regarding the use of asenapine for the treatment of schizophrenia (SZ) in adults. It covers an introduction, epidemiology, risk factors, pathophysiology, and current treatment modalities regarding SZ, provides a background on the mechanism of action of asenapine, and then reviews the existing evidence for use of asenapine in both its sublingual and transdermal formulation in the treatment of SZ.

Recent Findings

SZ is a complex and multifactorial mental disorder which is thought to combine several genetic, epigenetic, and environmental factors causing abnormalities in the dopaminergic system. Symptoms are categorized in delusions, hallucinations, disorganization, and negative presentations like affective flattening and apathy. Current treatment focuses on antipsychotic medications by means of oral administration or long-acting injection. Asenapine is a second-generation antipsychotic with 5HT-2A antagonist and 5HT-1A/1B partial agonist properties, which provides a favorable profile in targeting schizophrenic symptoms, while reducing motor side effects and improving mood and cognition. Asenapine in its sublingual formulation was FDA approved for treatment of SZ and bipolar I disorder in adults in August of 2009 and has been proven to be both effective and safe. Transdermal patch of asenapine (Secuado) was FDA approved in October of 2019, the first and only FDA approved patch for SZ in adults, which offers another strategy for treatment to improve compliance and ease of administration.

Summary

SZ is a chronic and debilitating disease which is still not well understood and comes at great cost with regards to the quality of life for patients. Medication side-effects and compliance are enormous issues which take a toll on health care systems in industrialized nations and keep patients from achieving stability with their disease. Transdermal asenapine is a new first-in-class dosage form and provides a novel modality of administration. It has been shown to be effective in reducing positive, as well as negative symptoms, while still maintaining a favorable side-effect profile.