title: Long-Acting Injectable Antipsychotics in Schizophrenia: Literature Review and Practical Perspective, with a Focus on Aripiprazole Once-Monthly.
abstract: Prevention of relapse is a major challenge in schizophrenia, a disease characterized by poor adherence to antipsychotic medication leading to multiple rehospitalizations and a substantial burden-of-care.
  
  
  
  We narratively review published clinical data from the development of long-acting injectable (LAI) formulations of antipsychotic drugs and examine the comparative effectiveness of oral versus LAIs in schizophrenia, with a focus on the second-generation LAI antipsychotic aripiprazole. Evidence is presented from studies with naturalistic/pragmatic as well as explanatory trial designs, supported by the clinical experience of the authors.
  
  
  
  LAI formulations of antipsychotic drugs offer advantages over oral medications and there is good evidence for their use as a first-choice treatment and in younger patients. Key phase III studies have shown aripiprazole once-monthly 400 mg (AOM 400) to be effective and well tolerated, with high rates of adherence and low rates of impending relapse. In a recent randomized trial with a "naturalistic" study design more representative of routine clinical practice, AOM 400 was well tolerated and had significantly greater effectiveness than paliperidone LAI overall and in younger patients aged ≤35 years.
  
  
  
  Results across the "full spectrum" of efficacy in traditional clinical trials as well as those encompassing the concept of effectiveness in a more naturalistic setting of real-life clinical practice support the use of AOM 400 as a valid long-term treatment option in schizophrenia overall, as well as earlier in the treatment course, and not solely in situations of poor adherence or when oral antipsychotics have failed.
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Biagi
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy.|PhD Program in Neuroscience, Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Capuzzi
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Colmegna
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mascarini
authors.affiliation: Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Brambilla
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ornaghi
authors.affiliation: Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Santambrogio
authors.affiliation: Department of Mental Health, ASST-Monza Ospedale San Gerardo, Monza, Italy. massimo.clerici@unimib.it.|Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy. massimo.clerici@unimib.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Clerici
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D000068180:Aripiprazole
keywords: Adherence; Hospitalization; LAI antipsychotics; Relapse; Remission; Schizophrenia and related psychotic disorders; Second-generation