Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics – expert consensus survey part 1

Abstract

Objective

To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use.

Methods

A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported.

Results

Recommendations aligned with research on risk factors for nonadherence and poor outcomes for patients with schizophrenia/schizoaffective or bipolar disorder. Findings suggested, contrary to general practice patterns, that LAI use may be appropriate earlier in the disease course and in younger patients. Results for bipolar disorder were similar to those for schizophrenia but with less consensus. Numerous facilitators of LAI prescribing were considered important, particularly that LAIs may reduce relapses and improve outcomes.

Conclusion

Findings support wider use of LAIs in patients with schizophrenia/schizoaffective and bipolar disorders beyond the setting of poor adherence and earlier use in the disease course.

Keywords:

• expert consensus
• schizophrenia
• schizoaffective disorder
• bipolar disorder
• long-acting injectable antipsychotics

Supplementary materials

Figure S1 Organization of survey.

Note: To simulate the treatment decision process, questions were organized into 3 main areas: identifying patients, initiation of therapy, and maintenance treatment.

Abbreviation: LAI, long-acting injectable antipsychotic.

Table S1 Survey respondents

Table S2 General summary of expert opinion on the top barriers to the use of LAIs in the field

Acknowledgments

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. Editorial support for the preparation of this manuscript was provided by Sheri Arndt, PharmD, and Alan Klopp, PhD, of C4 MedSolutions, LLC (Yardley, PA, USA), a CHC Group company, with funding from Otsuka Pharmaceutical Development & Commercialization, Inc., and H Lundbeck A/S.

Disclosure

MS, MB, CUC, and JMK received consulting fees from Otsuka for their roles in the beta testing of the survey and data analysis for this study. MS has received research support from the National Institutes of Health (NIH), Centers for Disease Control and Prevention, Janssen, Merck, Pfizer, Reinberger Foundation, Reuter Foundation, Alkermes, Otsuka, and the Woodruff Foundation; has been a consultant for Bracket, Neurocrine, Otsuka, Pfizer, Prophase, Health Analytics, and Supernus; has received royalties from Johns Hopkins University Press, Lexicomp, Oxford University Press, Springer Press, and UpToDate; has participated in CME activities for the American Physician Institute, CMEology, and MCM Education; and was compensated by Otsuka for her work on the survey development and data analysis for this study. SNL was an employee of Otsuka Pharmaceutical Development & Commercialization, Inc., at the time of the study. CUC has received grant or research support from the National Institute of Mental Health, the Patient Centered Outcomes Research Institute, The Bendheim Foundation, and Takeda; has served as a member of advisory boards/the Data Safety Monitoring Boards for Alkermes, IntraCellular Therapies, Lundbeck, Neurocrine, Otsuka, Pfizer, and Sunovion; and has served as a consultant to Alkermes, Allergan, the Gerson Lehrman Group, IntraCellular Therapies, Janssen/Johnson & Johnson, LB Pharma, Lundbeck, Medscape, Otsuka, Pfizer, ProPhase, Sunovion, Supernus, and Takeda. He has presented expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka and has received honorarium from Medscape and travel expenses from Janssen/Johnson & Johnson, Lundbeck, Otsuka, Pfizer, Sunovion, and Takeda. JMK has received honoraria for lectures and/or consulting from Alkermes, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Forrest, Genentech, Intracellular Therapeutics, Janssen, Johnson & Johnson, Lundbeck, Merck, Neurocrine, Novartis, Otsuka, Pfizer, Pierre Fabre, Proteus, Reviva, Roche, Sunovion, Takeda, and Teva and is a shareholder of MedAvante, LB Pharma, and The Vanguard Research Group. FD is an employee of Otsuka Pharmaceutical Development & Commercialization. HF is an employee of Lundbeck. RR is a paid consultant for Otsuka and was compensated for her work on the survey and data analysis. MB has received grant or research support from NIH and Otsuka. The authors report no other conflicts of interest in this work.