New approaches to antipsychotic medication adherence – safety, tolerability and acceptability

ABSTRACT

Introduction

Antipsychotic pharmacotherapy is considered a first-line treatment in schizophrenia-related disorders and is associated with favorable prognosis and lower mortality rates. However, low adherence rates present a major clinical challenge. In this paper, we will review contemporary approaches to improve adherence to antipsychotic treatment, considering their mechanism of action, safety, tolerability and acceptability.

Areas covered

Novel pharmacological delivery methods included different routes of administration of registered medications (such as intramuscular clozapine preparation and transdermal asenapine), modifications of existing compounds (such as 3-monthly injectable formulation of paliperidone palmitate), and increased interest in oral long-acting medication formulations (such as with penfluridol). In addition, we reviewed innovative technology to monitor adherence, based on the use of electronic digital medicine systems and ingestible sensors.

Expert opinion

All of these diverse approaches were clinically relevant in enhancing treatment adherence and found to be safe and tolerable. The place of each approach is predicated on a personalized approach in each patient, and future research could usefully use large comparative studies to establish robust treatment guidelines. The implementation of new and varied approaches to antipsychotic treatment adherence is welcomed and have the potential to make a significant impact on morbidity in this often difficult-to-treat population.

KEYWORDS:

• Schizophrenia
• adherence
• clozapine
• paliperidone palmitate
• penfluridol
• asenapine
• transdermal
• intramuscular

Article highlights

• Adherence to antipsychotic medications is a significant clinical issue in schizophrenia treatment. New technological and pharmacological approaches are being developed in order to improve patient adherence.

• Long-acting antipsychotics represent an important pharmacological avenue, particularly very long-acting injections (with administration interval ranging between 3 and 6 months) and oral long-acting formulations.

• Modifications of available treatments are another important direction. This includes new administration routes like short-acting IM clozapine preparations (serving as a bridge for oral clozapine administration) and novel transdermal delivery systems.

• Innovative technologies can monitor intake of antipsychotic medications. Portable device to measure clozapine blood levels and sensor-based digital systems are being studied.

• All above mentioned approaches were found to be promising, safe, and acceptable in recent clinical trials.

Declaration of interests

SS Shergill has received grant funding for clinical trials and/or honoraria for educational input from Boehringer Ingelheim, Otsuka, Takeda, and Lundbeck over the last 5 years. He was supported by a European Research Council Consolidator Award (Grant Number 311,686) and the NIHR Mental Health Biomedical Research Centre at SLAM NHS Foundation Trust and King’s College London. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.