title: Comparison of Injectable and Oral Antipsychotics in Relapse Rates in a Pragmatic 30-Month Schizophrenia Relapse Prevention Study.
abstract: In a pragmatic clinical trial, this study sought to compare relapses among patients receiving either long-acting injectable or oral second-generation antipsychotics.
  
  
  
  PROACTIVE (Preventing Relapse Oral Antipsychotics Compared to Injectables Evaluating Efficacy), a prior 30-month relapse prevention study, compared use of a long-acting injectable second-generation antipsychotic with use of an oral second-generation antipsychotic by 305 patients with schizophrenia or schizoaffective disorder and found similar rates of first relapse between groups (42% with injectable medication, 32% with oral medication). This study examined subsequent relapses among patients who had relapsed in PROACTIVE and who continued in treatment, follow-up, or both.
  
  
  
  Thirty-two patients (11%) experienced two relapses, and 13 patients (4%) had three relapses. Neither rate of relapse nor time to successive relapses differed between treatment groups.
  
  
  
  There was an impressively low rate of subsequent relapses in this pragmatic clinical trial. Because all patients had a clinic visit according to the biweekly long-acting injectable medication administration schedule, frequent contact may have contributed to low relapse rates. Maintaining frequent clinical contact may be a valid psychosocial relapse prevention treatment.
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Buckley
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Schooler
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Alex
authors.initials: A
authors.lastname: Kopelowicz
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: John
authors.initials: J
authors.lastname: Lauriello
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Theo C
authors.initials: TC
authors.lastname: Manschreck
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Alan
authors.initials: A
authors.lastname: Mendelowitz
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Del D
authors.initials: DD
authors.lastname: Miller
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wilson
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Donna
authors.initials: D
authors.lastname: Ames
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Bustillo
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.affiliation: Dr. Buckley is with the Department of Psychiatry and is dean of the Medical College of Georgia Regents University, Augusta, where Dr. Looney is affiliated with the Department of Biostatistics and Epidemiology (e-mail: pbuckley@gru.edu ). Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn. Dr. Goff is with the Department of Psychiatry, New York University Medical Center, New York City. Dr. Kopelowicz and Dr. Ames are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Lauriello is with the Department of Psychiatry, University of Missouri, Columbia. Dr. Manschreck is with the Department of Psychiatry, Harvard Medical School, Fall River, Massachusetts. Dr. Mendelowitz is with the Department of Psychiatry and Dr. Kane is with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Miller is with the Department of Psychiatry Research, University of Iowa Hospital, Iowa City. Dr. Wilson is with the Department of Psychiatry, University of Florida Health Science Center, Jacksonville. Dr. Bustillo is with the Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Looney
mesh_terms: D000284:Administration, Oral; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy*; D012008:Recurrence; D018967:Risperidone / Q000008:administration & dosage* / Q000009:adverse effects; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone