Schizophrenia has long presented treatment challenges for both patients who have the mental illness and the treatment providers who want to help them. Many medications prescribed for schizophrenia have traditionally not always been well-tolerated in patients, with sometimes significant side effects in some.
Schizophrenia is a condition characterized by the person experiencing hallucinations and/or delusions, sometimes of a persecutory nature. It is usually first diagnosed in young adulthood — typically in a person’s 20s — and more often among men than women. Although usually severe in nature, it is also a relatively rare mental illness that appears to affect less than 0.5% of the population.
Untreated schizophrenia often results in a poor quality of life, with many being unable to take care of the basic necessities of life such as shelter, food, and providing for oneself. A person with untreated schizophrenia is also more likely to be affected with a wide range of general health problems, too.
Traditional treatment for schizophrenia has long relied on taking oral antipsychotic medications on a regular schedule (once, twice or three times daily). Antipsychotics taken this way have shown to be effective in a large percentage of patients who are prescribed them.
However, the problem arises that when a patient has been stabilized on an antipsychotic drug, they often feel well enough to discontinue the medication, often on their own. Discontinuation leads to a return of symptoms and often a deterioration in the patient’s life functioning and status. This cycle often repeats in a patient with schizophrenia’s life for years.
There are also a lot of other issues that affect a person’s ability to take a medication as it was prescribed. These factors can include “cognitive impairment, substance use, depressive symptoms, adverse effects, inconvenient medication regimen, feelings of being stigmatized, and prejudiced attitude and beliefs in an illness mode” (Liu et al, 2013).
Enter a new albeit more expensive alternative treatment for schizophrenia — an injection of a medication given to a patient once every week or few weeks. Referred to as Long-Acting Injectables (or LAIs), these medications don’t require the daily effort it takes to remember to take a regular medication. And because they typically require an appointment with a professional to obtain, it ensures regular contact with the mental health care system.
This treatment alternative is an important addition to address the problem of long-term treatment adherence in patients with schizophrenia. When patients with schizophrenia relapse, they often require rehospitalization and are at a higher risk of suicide. Reducing relapse rates in schizophrenia is therefore important. New treatment strategies must be tried.
Long-acting injectables include both antipsychotics and atypical antipsychotics. Some antipsychotic medications, like fluphenazine decanoate (Modecate) are available in tablets, liquid form and as an injectable. In the UK and other non-US countries, flupentixol decanoate (known as Depixol or Fluanxol) is also available.
Atypical antipsychotic injectables include risperidone long-acting injectable (Risperdal Consta suspension for injection) and paliperidone palmitate (Invega Sustenna or Xeplion), a long-acting injectable form of paliperidone. Another form of risperidone called Perseris is also approved for the treatment of schizophrenia in adults. All injectables require only once-monthly injections by a trained healthcare professional.
Research on long-acting injectables for schizophrenia show generally promising results. In a study of 652 subjects examining the efficacy of different doses of Invega Sustenna, researchers found significantly greater improvement during treatment with 156-mg and 234-mg doses compared with placebo on a range of schizophrenia symptom measures (Sliwa et al., 2011). Efficacy for Perseris was assessed in a Phase 3 randomized, double-blind, placebo-controlled study of 354 adults with schizophrenia evaluated by two clinical scales: PANSS and CGI-S (Isitt, et al., 2016).
Other studies have shown that the newer atypical antipsychotics injectables (such as Risperdal Consta and Invega Sustenna) are equivalent in efficacy, and have similar levels of side effects.
Long-acting treatments are a valuable addition to the arsenal of treatment tools used to successfully treat schizophrenia. While not appropriate for everyone, it’s another option to consider if a person with schizophrenia is having a difficult time maintaining their treatment efforts with traditional psychiatric medications.