title: Effectiveness of long-acting antipsychotics in clinical practice : 1. A retrospective, 18-month follow up and comparison between paliperidone palmitate, risperidone long-acting injection and zuclopenthixol decanoate.
abstract: OBJECTIVE
  In the UK, nine different compounds are available as long-acting antipsychotic injections (LAIs). There are few clinical guidelines for determining which LAIs are most effective in specific patient groups. To measure the clinical effectiveness of LAIs we aimed to determine the now-established concept of antipsychotic discontinuation rates and measure Clinical Global Impression (CGI) outcomes.
  
  
  METHODS
  The population (n was approximately 560,000) was a secondary care NHS adult mental health service in Lanarkshire, Scotland, UK. This was a retrospective, electronic case note search of LAI-naïve patients commenced on paliperidone palmitate (n = 31), risperidone long-acting injection (RLAI) (n = 102) or zuclopenthixol decanoate (n = 105), with an 18-month follow up. Kaplan-Meier survival statistics for discontinuation rates and hospital admission were calculated. CGI severity and improvement scores were retrospectively assigned by the investigating team.
  
  
  RESULTS
  Paliperidone palmitate performed less favourably than risperidone long-acting injection (RLAI) or zuclopenthixol decanoate. Paliperidone palmitate had higher discontinuation rates due to any cause, inefficacy and increased hospitalization risk. Paliperidone palmitate had the smallest proportion of patients assigned a clinically desirable CGI-I score of 1 (very much improved) or 2 (much improved).
  
  
  CONCLUSIONS
  Paliperidone palmitate had less favourable discontinuation and CGI outcomes compared with RLAI and zuclopenthixol decanoate. This could not be adequately explained by patients in the paliperidone group being more chronically or severely unwell, nor by the presence of comorbidities such as alcohol or substance misuse, or by the use of lower mean dosages compared with RLAI or zuclopenthixol decanoate. We considered that prescribers are familiarizing themselves with paliperidone and outcomes may improve over time.
authors.affiliation: NHS Lanarkshire, Bellshill, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cordiner
authors.affiliation: NHS Lanarkshire, Bellshill Clinic, Greenmoss Place, Bellshill ML4 1PS, UK.
authors.forename: Polash
authors.initials: P
authors.lastname: Shajahan
authors.affiliation: NHS Lanarkshire, Bellshill, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: McAvoy
authors.affiliation: NHS Lanarkshire, Bellshill, UK.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Bashir
authors.affiliation: NHS Lothian, Edinburgh, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Taylor
keywords: antipsychotics; clinical effectiveness; discontinuation; long-acting psychotics