Comparing Real-World Data on LAIs and Oral Antipsychotics
What do real-world data reveal about the effectiveness of long-acting injectable (LAI) antipsychotics compared to oral agents? In this video, Craig Chepke, MD, DFAPA, Chief Medical Officer, Psych Congress, discusses real-world findings that clinicians should be aware of when considering the use of oral or LAI antipsychotics for schizophrenia treatment. Dr Chepke also highlights the differences between LAI options that have emerged in these studies, offering clinicians further considerations for selecting a treatment option that will best benefit their patients.
Key Takeaways for Clinical Practice:
- LAI antipsychotics vs oral antipsychotics: Real-world data show LAIs provide longer time to treatment failure (psychiatric hospitalization, death, incarceration) compared with oral agents.
- Longer-interval LAIs: Paliperidone palmitate 3-month (PP3M) demonstrated a statistically significantly longer time to treatment failure than paliperidone palmitate 1-month (PP1M).
- Clinical implication: Emerging evidence suggests a tiered benefit—LAIs outperform orals, and longer-duration LAIs may offer added advantage, supporting consideration of transitioning stable patients from shorter- to longer-interval formulations.
Read the Transcript
Craig Chepke, MD, DFAPA: Hi, my name is Craig Chepke. I'm a psychiatrist in private practice at Excel Psychiatric Associates in Huntersville, North Carolina. I'm also an adjunct associate professor of psychiatry for Atrium Health in Charlotte, North Carolina, and the [Chief Medical Officer] for the Psych Congress organization.
Psych Congress Network: Considering the latest clinical and real-word data on LAIs, what are some of the most compelling findings that clinicians should be paying attention to when comparing LAIs to oral antipsychotics?
Chepke: We've known for a while that there are advantages to LAIs over oral antipsychotics in a lot of different ways, mostly from randomized clinical trial data. But we're starting to get a lot of really fascinating real-world data about LAIs compared to oral medications.
A study that I went over in my presentation on LAIs at NP Institute had real-world data looking at the time to treatment failure. Treatment failure was a composite endpoint of multiple different ways that [participants] could achieve it, which was all bad things, of course: psychiatric hospitalization, death, incarceration, things of that nature.
There was an overall improvement for LAIs compared to oral antipsychotics, which I would have expected. But what was really interesting was that there was also a potential advantage for longer duration LAIs compared with shorter duration LAIs. For instance, for paliperidone palmitate 3-month (PP3M), there was a much longer, statistically significantly longer time to treatment failure for PP3M compared to paliperidone palmitate 1-month (PP1M). That's really interesting, that the longer-duration LAI could confer even greater advantages compared to the oral counterparts.
We see a tier system evolving where any LAI is more or less better than oral medications, but it's possible that with that real-world study and then others that we've looked at, that there could be also longer duration LAIs conferring an even greater advantage. So we should really think about, is it time to move some of our patients on the shorter duration LAIs to a longer duration LAI?
I want to thank you for watching this video today. I urge you to check back here for more practical and actionable updates, which I hope is what you got from today's video.
Craig Chepke, MD, DFAPA, is a Board-Certified psychiatrist in clinical practice as the medical director of Excel Psychiatric Associates in Huntersville, NC, and is an Adjunct Associate Professor of Psychiatry for the Sandra and Leon Levine Psychiatry Residency Program at Atrium Health. He attended NYU School of Medicine and completed his psychiatry training at Duke University. As part of an interdisciplinary treatment team in his practice, he employs a person-centered care model to tailor treatments to each individual's needs, integrating traditional pharmacotherapy with psychotherapeutic and physical health and wellness interventions. His clinical and academic interests include serious mental illness, movement disorders, ADHD, and sleep medicine. Dr Chepke is the Chief Medical Officer for the Psych Congress portfolio of CME conferences, and he has been recognized as a Distinguished Fellow of the American Psychiatric Association.
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