title: Factors associated with relapse in schizophrenia despite adherence to long-acting injectable antipsychotic therapy.
abstract: Many patients with schizophrenia will relapse despite uninterrupted antipsychotic (AP) long-acting therapy (LAT). This exploratory analysis examined variables associated with relapse despite ensured adherence to LAT. This was a post-hoc exploratory analysis of a 1-year study of risperidone long-acting injection in patients with stable schizophrenia or schizoaffective disorder (NCT00297388; N=323). Patients were discontinued from previous oral APs and randomly assigned to biweekly intramuscular injections of risperidone long-acting injectable 50 (n=163) or 25 mg (n=161) for 52 weeks. Cox proportional hazards regression models examined variables putatively associated with relapse. A total of 59/323 (18.3%) patients relapsed over 12 months despite continuous AP LAT. Variables associated with the risk of relapse included illness duration (6.0% increase each year; P=0.0003) and country (Canada vs. USA, 4.7-fold risk increase; P=0.0008). When illness duration was further categorized as ≤5, 6-10, and >10 years, patients with an illness duration of >10 versus ≤5 years were at greatest risk of relapse (>10 vs. ≤5 years associated with a 4.4-fold increase in the risk of relapse; P=0.0181). Findings suggest that patients with more chronic illness have a greater risk of relapse despite ensured treatment adherence, supporting the need for early intervention to prevent the deleterious effects of chronicity.
authors.affiliation: aJanssen Scientific Affairs bJanssen Research & Development, LLC, Titusville, New Jersey cSaint Louis University School of Medicine, St Louis, Missouri, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Alphs
authors.forename: Henry A
authors.initials: HA
authors.lastname: Nasrallah
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Bossie
authors.forename: Dong-Jing
authors.initials: DJ
authors.lastname: Fu
authors.forename: Srihari
authors.initials: S
authors.lastname: Gopal
authors.forename: David
authors.initials: D
authors.lastname: Hough
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Turkoz
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D038622:Internationality; D008297:Male; D055118:Medication Adherence; D012008:Recurrence; D018967:Risperidone / Q000008:administration & dosage*; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone