Long-Acting Injectable Antipsychotic To Prevent Relapse in First Episode Schizophrenia

JAMAResearch published in JAMA Psychiatry demonstrated that long-acting, injectable, second-generation antipsychotic medication has tremendous potential to bring clinical stability to persons with first-episode schizophrenia. According to the authors, “long-acting medications are rarely used following a first episode of schizophrenia.”

Patients with recent onset of schizophrenia (n=86) were randomized to receive long-acting injectable risperidone or oral risperidone. Half of each group was also randomized to receive cognitive remediation to improve cognitive functioning or healthy-behaviors training to improve lifestyle habits and well-being.  The study showed that there was a significant and dramatic difference in 12-month relapse rates between the groups, favoring LAI risperidone. “The psychotic exacerbation and/or relapse rate was 5% in the LAI risperidone group vs 33% in the oral risperidone group ― a relative risk reduction of 84.7%. Treatment with LAI risperidone also provided better control of hallucinations and delusions.”
Obviously, adherence to medication was better with the LAI groug; it was also associated with prevention of exacerbation and/or relapse and control of breakthrough psychotic symptoms. What was interesting to note was that the LAI antipsychotic medication was readily accepted by schizophrenia patients soon after the onset of the disorder. The authors concluded that “the use of long-acting injectable risperidone after a first episode of schizophrenia has notable advantages for clinical outcomes. The key clinical advantages are apparently owing to the more consistent administration of the long-acting injectable. Such formulations should be offered earlier in the course of illness.”


JAMA Psychiatry. Published online June 24, 2015.