In the first of two webinars, John Kane, Professor and Chairman of Psychiatry at The Donald and Barbara Zucker School of Medicine, New York, USA, provided a rationale for the use of long-acting injectable (LAI) antipsychotics in early-phase schizophrenia. He then introduced PRELAPSE1, a large-scale, multicentre LAI study of patients with early-phase schizophrenia, which, by challenging perceptions that LAIs are a treatment of ‘last resort’ with a low patient acceptance rate, should have implications for future clinical practice.

Professor Kane said it is widely recognised that antipsychotic medication is highly efficacious, citing a meta-analysis² that compared various medications with placebo for the prevention of relapse and found the number needed to treat (NNT) was 3. He said the challenge was how to ensure patients continue taking their medication regularly when this is a struggle for many people living with chronic illness.^3,4 Professor Kane said that relapse rates are high, even after one episode, referencing a study that showed 82% of patients had a relapse within 5 years.⁵ Patients who discontinued their medication were almost 5 times more likely to relapse compared with those who continued treatment.⁵

The importance of preventing relapse 

Patients are at risk of experiencing disease progression after each relapse,⁶ and their response rates to medication can be significantly reduced.⁷ Professor Kane said other possible consequences of first and second relapses in early-phase schizophrenia included increased use of healthcare resources, long-term symptoms and social disability, increased risk of self-harm, and increased burden on care givers.⁸ He believes not continuing antipsychotic medication after a first episode is risky, and noted that continued treatment increases the chance of survival compared with stopping medication.⁹

The rationale for using LAIs

It has been suggested that LAIs may be more efficacious than their oral counterparts: a Finnish cohort study¹⁰ of selected antipsychotics found that within 60 days of leaving hospital, less than half (45.7%) the patients who had experienced a first episode were adhering to their antipsychotic medication. In that study’s pairwise comparisons between four LAIs and their equivalent oral formulations, no statistically significant differences in rehospitalisation risk were observed between pairs. However, in its pooled analysis, the LAIs were associated with a statistically significant lower risk of rehospitalisation (p=0.007).¹⁰ 

The PRELAPSE study

The Prevention of Relapse in Schizophrenia (PRELAPSE) study was an investigator-initiated, multicentre, cluster-randomised clinical trial with a 2-year follow-up.¹

The objective of PRELAPSE was to understand the acceptability of treatment with LAIs in patients with early-phase or first episode schizophrenia and to determine if encouraging the use of an LAI antipsychotic delays the time to first psychiatric hospitalisation compared with clinician’s choice of treatment.^1,11

For more information about PRELAPSE and the study outcomes, click here. 

Click here to read Part 2, which provides practical tips on how to train staff to offer LAIs in ways that enhance patient acceptance.