Older Long-Acting Injectable Antipsychotics an Effective, Less-Expensive Option for Patients with History of Non-Adherence

NEW YORK, NY (May 19, 2014) – A study of long-acting injectable antipsychotics for people with schizophrenia found that the newer, second-generation, medication paliperidone palmitate was no more effective than the older, less expensive haloperidol decanoate. This was so, even though the doses of the older medication given in the study were considerably lower than standard doses of the past. The study will be published in the May 21st issue of JAMA.

Scott Stroup, MD, MPH, and colleagues affiliated with the National Institute of Mental Health-supported Schizophrenia Trials Network compared the two medications in 311 patients diagnosed with schizophrenia or schizoaffective disorder. “The two drugs were very similar to each other, and both were better than expected at preventing relapse,” said Dr. Stroup, a professor of psychiatry at Columbia University and the New York State Psychiatric Institute.

Treatment adherence is a challenge for many patients with schizophrenia, especially with oral medications that must be taken daily. Many experts believe that the use of long-acting injectable antipsychotics to improve adherence is underused.

“The use of long-acting injectable medications is an important strategy that may lead to fewer relapses and better outcomes,” said Dr. Stroup. “We should think of using long-acting injectables when there is a risk of relapse due to medication non-adherence. But it's not necessary to start with an expensive, new long-acting medication.”

“This study,” he said, “also demonstrates the importance of independently funded research to provide unbiased comparisons of new and established medications. Comparative effectiveness research studies such as this one help determine the appropriate role for new treatments.”

Though few study participants in either group stopped treatment because of side effects, the drugs tended to have different side effects. Patients who were assigned the newer antipsychotic reported more weight gain, while those assigned the older antipsychotic had more neurologic side effects, particularly restlessness. All patients, therefore, should be carefully monitored throughout treatment, said Dr. Stroup.

The study was funded by the National Institute of Mental Health grants (R01MH081107 an dR01MH081234).

The title of the paper is “Effectiveness of Paliperidone Palmitate vs. Haloperidol Decanoate for Maintenance Treatment of Schizophrenia: A Randomized Clinical Trial.” The other contributors are Joseph P. McEvoy and Peter F. Buckley (Georgia Regents University); Matthew Byerly (UT Southwestern Medical Center); Robert M. Hamer, Rosalie Dominik, Neepa Ray and Tania M. Wilkins (University of North Carolina); Marvin S. Swartz (Duke University); and Robert A. Rosenheck (Yale University).

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