Initiating/maintaining long-acting injectable antipsychotics in schizophrenia/schizoaffective or bipolar disorder – expert consensus survey part 2

Abstract

Objective

The aim of this study was to provide recommendations on initiating and maintaining long-acting injectable antipsychotics (LAIs) in individuals with schizophrenia/schizoaffective or bipolar disorder.

Methods

A 50-question survey comprising 916 response options was completed by 34 expert researchers and high prescribers with extensive LAI experience, rating relative appropriateness/importance on a 9-point scale. Consensus was determined using chi-square test of score distributions. Results of 21 questions comprising 339 response options regarding LAI initiation, maintenance treatment, adequate trial definition, identifying treatment nonresponse, and switching are reported.

Results

Experts agreed that the most important LAI selection factor was patient response/tolerability to previous antipsychotics. An adequate therapeutic LAI trial was defined as the time to steady state ± 1–2 injection cycles. Experts suggested that oral efficacy and tolerability should be established before switching to an LAI, without consensus on the required time, and that the time for oral supplementation and next injection interval should be determined by the time to attainment of therapeutic LAI levels. Most experts agreed that ≥1 adequate LAI trial is needed to identify the lack of efficacy. There was little agreement about strategies for switching between LAIs.

Conclusion

Expert guidance may aid clinicians in their decisions regarding initiating/maintaining LAIs in individuals with schizophrenia/schizoaffective or bipolar disorder.

Keywords:

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

Supplementary material

Table S1 Frequency of medical monitoring during and after the first 6 months of treatment with LAIs

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 continuing medical education 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. RR is a paid consultant for Otsuka and was compensated for her work on the survey and data analysis by Otsuka. SNL was an employee of Otsuka Pharmaceutical Development & Commercialization, Inc. at the time of the study. MB has received grant or research support from the NIH and Otsuka. 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. 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, Intra-Cellular Therapies, Lundbeck, Neurocrine, Otsuka, Pfizer, and Sunovion; 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; 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. The authors report no other conflicts of interest in this work.