Impact of early use of long-acting injectable antipsychotics on functional outcome in first episode psychosis: a 3-year longitudinal study

Abstract

Objectives

To describe, in a naturalistic setting, the impact of the early use of LAI-AP on functional outcomes of early psychosis patients as compared to oral antipsychotics (OAP).

Methods

Longitudinal prospective 3-year naturalistic study of all consecutive admissions (n = 416) to two Early intervention services (EIS) for psychosis comparing baseline characteristics and the evolution of global functioning, occupation (work and studies), and living arrangements autonomy according to the route of administration of the antipsychotic medication. The cohort was divided into four groups: LAI-AP first (started on LAI-AP and later received OAP), OAP first, LAI-AP only, and OAP only.

Results

Global assessment of functioning (GAF) improved in all groups, but our mixed-effect model did not show any significant association between the route of administration and the GAF outcome. The LAI-AP only group was significantly less likely to have extreme residential instability at 3 years than the other groups despite its highest proportion of homeless youth and their poor prognostic factors at baseline.

Conclusions

Our naturalistic study suggests a significant protective effect of LAI-AP on extreme residential instability for the most vulnerable patients, but no impact of the first AP administration route on other functional outcomes was observed at 3 years of follow-up.

Key points

• Long-acting injectable antipsychotics seem promising to avoid extreme residential instability in early psychosis.

• Global assessment of functioning (GAF) improved in all groups.

• There was no significant association between the first route of administration and global functionning.

Keywords:

• Schizophrenia
• first-episode psychosis
• long-acting injectable antipsychotic
• functional outcome
• employment
• homelessness

Acknowledgments

We would like to thank Ramzan Tahir and Martin Ladouceur, biostatisticians at CRCHUM at the time of this study and who conducted all the statistical analyses. SP is the holder of the Eli Lilly-Université de Montréal Chair in Schizophrenia Research.

Disclosure statement

AAB received research funds from Fonds de Recherche en Santé du Québec (FRQS) and the Canadian Institutes of Health Research (CIHR). More than 3 years ago, AAB received speaker fees and research grants from Janssen-Ortho, and has also received research funds for a master's student grant from Otsuka-Lundbeck and has been part of one of its advisory committees. SP is the holder of a grant from Otsuka Pharmaceuticals. ES received funding from Fond de Recherche du Québec en Santé—Partenariat JANSSEN 2020, University of Arab Emirates, and CMHS 2020. The other authors declare no conflict of interest.

Additional information

Funding

Funding sources for this study were: Foundation IUSMM; Foundation CHUM; Eli Lilly Chair in Schizophrenia Research at Université de Montréal; Research funds from the Department of Psychiatry of CHUM; Bristol-Myers-Squibb Canada (unrestricted grant); Janssen Ortho (unrestricted grant); and Otsuka-Lundeck (student grant).