Use of long-acting injectable antipsychotics is often reserved for patients with chronic or treatment-refractory schizophrenia or repeated non-compliance issues. However, recent studies have consistently found a role for these treatments both soon after diagnosis and in the treatment of chronic disease.
A severe and often debilitating neurodevelopmental disorder, schizophrenia affects a person’s ability to think clearly, manage emotions, make decisions, and relate to others. The early onset and chronic course of the disease make it a disabling condition for both patients and their families. Schizophrenia also represents a significant and growing economic burden, with an estimated global cost that rose from U.S. $62.7 billion in 2002 to U.S. $100 billion in 2015.
While oral antipsychotic medications are effective in reducing the core symptoms of schizophrenia, the rate of treatment discontinuation and the subsequent risk of relapse is high. Given the increased risks of mortality and significant morbidity resulting from partial or non-adherence, there is a critical need for solutions that improve medication adherence. Although long-acting injectable (LAI) antipsychotic medications have been linked to greater compliance, their use in clinical practice remains low, and ongoing research is needed to clarify their role in the treatment of schizophrenia.
In this white paper, we will review the symptomatology and pathophysiology of schizophrenia and discuss the pros and cons of treatment with LAIs. We will also explore the challenges of conducting studies in schizophrenia and offer suggestions for maximizing the likelihood of success in clinical trials of these drugs.
Background
Schizophrenia is a complex, chronic neurodevelopmental disorder characterized by a heterogeneity of presenting signs and symptoms. The disease course is marked by acute psychotic episodes with longer interim periods of improved, yet sometimes chronic symptoms.