Risk of discontinuation of antipsychotic long-acting injections vs. oral antipsychotics in real-life prescribing practice: a community-based study.
OBJECTIVE
To compare the risk of discontinuation of ambulatory antipsychotic treatment in persons treated with antipsychotic long-acting injections (LAIs) or by oral antipsychotics (OAPs).


METHODS
The study was performed in a representative sample of persons newly treated with OAPs (n = 6904) affiliated to the French Insurance Healthcare system. The risk of all-cause discontinuation was compared in patients prescribed OAPs (n = 246) vs. matched patients prescribed LAIs (n = 246) using multivariate survival analyses. Confounding by indication was minimized by matching on type of antipsychotic drug and by the high-dimensional propensity score method.


RESULTS
Discontinuation was more frequent with OAPs (69%) compared to LAIs (57%) [adjusted relative risk (aRR) = 1.6, 95% CI 1.23-2.07]. Risk of discontinuation was higher for first-generation (FGA) OAPs vs. FGA LAIs (aRR = 1.94, 95% CI 1.22-3.08) as well as for second-generation (SGA) OAPs vs. SGA LAIs (aRR = 1.58, 95% CI 1.15-2.17). Over the 6-month period after discontinuation of LAIs, a new antipsychotic drug was dispensed in 58% of patients, the most frequent pattern being dispensing of the same LAI as that prescribed before discontinuation.


CONCLUSIONS
Although less frequent than with OAPs, the rate of ambulatory treatment discontinuation was high with LAIs. Prescription of LAIs should be associated with intervention strategies aimed at promoting medication adherence.
INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.|Centre Hospitalier Charles Perrens, Bordeaux, France.
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http://orcid.org/0000-0003-2948-3782
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Verdoux
INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.
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E
Pambrun
INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.|Centre Hospitalier Charles Perrens, Bordeaux, France.
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M
Tournier
INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.
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J
Bezin
INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.
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A
Pariente
D000284:Administration, Oral; D000328:Adult; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000145:classification / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D005260:Female; D005602:France; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations
antipsychotic long-acting injection; discontinuation; first-generation antipsychotic; second-generation antipsychotic