Long-acting injectable medication maintenance treatment of “first-episode” schizophrenia – a randomized effectiveness study

Presentation First Author: 
Peter Weiden

Background: Because long-acting injectable (LAI) antipsychotics are largely reserved for persistently ill patients, little is known about the use of LAIs for “first-episode” outpatients. Methods: A prospective randomized controlled trial (RCT) between 12/2004 and 3/2007 of “first-episode” DSM-IV schizophreniform, schizophrenia, or schizoaffective disorder treated in an urban, public mental health service. Subjects were randomized at a 2:1 ratio to recommendation of LAI risperidone microspheres (RLAI) (n = 26) or continuation oral antipsychotic (ORAL) (n = 11), for up to 104 weeks. Primary outcomes were time until initial nonadherence (medication gap of ≥14 days), and medication attitudes assessed with the Rating of Medication Influences (ROMI) scale. Results: Over 80% of patients stopped medication within 104 weeks. There was an early adherence benefit favoring RLAI acceptors at 12 weeks, but no significant difference between RLAI and ORAL in time to initial nonadherence during the overall study. Medication attitudes did not differ between groups. Treating clinicians missed over 75% of nonadherent gaps in “real time”, creating an illusion that nonadherence was more likely to occur in LAI subjects. Conclusions: Acceptance of RLAI was associated with an initial adherence benefit that was not sustained over time. Recommendation of LAI does not adversely affect adherence attitudes in first-episode patients. The small size of the study and low power limits interpretation, but the few patients who remained adherent into a second year were all receiving RLAI. Nonadherence was more easily detected among first-episode patients treated with LAI therapy than it was with oral antipsychotic.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Peter Weiden, Nina Schooler
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