Reducing the stigma of long acting injectable antipsychotics – current concepts and future developments

Abstract

Background: Long acting injectable antipsychotics (LAI-APs) are considered a major advance in psychiatric treatment concerning treatment adherence and outcomes. Yet, both, doctors and patients remain sceptical.

Aim: To explain the rationale for using LAI-APs, review their effectiveness and explore barriers to use.

Method: Clinical overview of LAI-APs from the patient and doctor’s perspective.

Results: LAI-APs were developed to increase adherence to treatment, thereby improving treatment outcomes. LAI-APs may reduce the risk of relapse and hospitalisation. Yet, the evidence from the few meta-analyses available remains weak. Both patients and doctors may associate LAI-APs with stigma and coercion. Current means of improving adherence include more focus on the therapeutic relationship, better information, adverse effects minimisation and half-life extension of LAI-APs. Future means of improving adherence include novel administration techniques that abolish the need for injection.

Conclusions: For both, clinicians and drug developers, drug adherence remains a major target for improving treatment outcomes.

Keywords:

• Antipsychotics
• long-acting injections
• adherence
• relapse
• blood-brain-barrier

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Notice of duplicate publication: Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry – Diagnostics and Treatment, Luleå Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London)

Disclosure statement

David Taylor has received grant/research support from Janssen, Lundbeck and Sunovion and honoraria or consultation fees from Janssen, Otsuka, Servier Lundbeck and Sunovion. David Taylor is an advisory board member of Allergan.

Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018, EAPM 2016 Luleå, Sweden): Astra Zeneca, Janssen, Eli Lilly, Novartis, Otsuka/Lundbeck, Servier, Sunovion and Shire.

Sitaram Velaga declares that there is no conflict of interest.

Table 1. Summary of form of active drugs and formulation details of different LAIs available in the US, UK and EU (modified from Remenar 2014) [29].