Long-acting injectable antipsychotics for schizophrenia are underutilized in Canada

A Canadian study has analyzed the “real-world” prevalence of long-acting injectable antipsychotic use among Canadian patients with schizophrenia. The study also examined when these drugs are started relative to other antipsychotic medications in the course of the patient’s disease. The retrospective, longitudinal cohort study examined Canadian pharmacy prescription data from mid-2005 to mid-2017. Data from patients with schizophrenia were analyzed for a minimum 12 months, beginning from the date of their first antipsychotic prescription, to track the types of antipsychotic therapy used and long-acting injectable antipsychotic utilization. A total of 16,300 patients were included in the analysis. Read: What we know (and what we don't) about clinical use of psychedelic drugs Results showed that 48.2% of index antipsychotic prescriptions were prescribed by a general practitioner/family medicine physician and 46.0% by a psychiatrist. Only 1,062 (6.5%) patients used a long-acting injectable antipsychotic during the study period. Of these patients, 789 (74.3% of long-acting injectable antipsychotic users; 4.8% of all patients) used a long-acting injectable antipsychotic within two years of their first antipsychotic prescription. The study also found that the majority of long-acting injectable antipsychotic use (62.0%) occurred as the third line of therapy or later. Despite the potential of long-acting injectable antipsychotic use to reduce relapse in schizophrenia by improving treatment adherence, this study showed that these agents are underutilized in Canada. In addition, when long-acting injectable antipsychotics are used, they tend to be positioned late in the sequencing of antipsychotic medications and are often not initiated until years after diagnosis. Read: How to prevent, assess and treat depression among older adults The authors contend that continued preference for oral antipsychotics with poor adherence may be negatively affecting prognosis and exacerbating the burden of schizophrenia. Further study is needed to understand the barriers to long-acting injectable antipsychotic uptake and greater efforts are needed to promote earlier and more widespread use of these agents. Reference 1. Agid O, Remington G, Fung C, et al. Real-world utilization patterns of long-acting injectable antipsychotics in Canada: a retrospective study. Can J Psychiatry 2021; Published online November 18, 2021. https://doi.org/10.1177/07067437211055413.

Long-acting injectable antipsychotics for schizophrenia are underutilized in Canada

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