Early Discontinuation of LAIs in Schizophrenia Linked to Higher Readmission Rates

Shared decision-making offers better outcomes for medication adherence, particularly for adopting and adhering to LAI regimens.

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Results from a new study suggest that patients with schizophrenia experiencing their first hospitalization face a significantly higher risk of readmission if they prematurely discontinue long-acting injectable antipsychotics (LAIs). The findings, published in JAMA Network Open, provide insights into the efficacy of LAIs in managing schizophrenia and optimizing treatment outcomes.¹

Conducted in Taiwan and involving more than 56,000 patients, the research found that maintaining continuous LAI treatment during initial hospital stays dramatically lowers the likelihood of relapse and subsequent hospitalization, highlighting the critical role of consistent medication management in early stages of schizophrenia care.

A recent article emphasized the importance of shared decision-making (SDM) in this population. Not only is it associated with patient satisfaction and empowerment, but it aligns with the value of patient-centered mental health recovery and offers better outcomes for medication adherence, particularly for adopting and adhering to LAI regimens.²

Investigators of the current study evaluated the prevalence of LAI in-hospital utilization by assessing how frequently LAIs are prescribed during the first admission for schizophrenia.¹ They also examined the impact of early discontinuation to determine whether early discontinuation of LAIs during hospitalization affected the risk of subsequent readmission for psychotic disorders.

Data for the investigation were gathered from a comprehensive claims database spanning 2004 to 2017, encompassing 56,211 patients with first-time admissions for schizophrenia. Patients were categorized into 3 groups based on their exposure to LAIs during hospitalization: those who did not receive LAIs (83.4%), those with LAIs and early discontinuation (10.1%), and patients who received LAIs and continued them throughout hospitalization (6.5%).

Results demonstrated that patients who received LAIs but discontinued them early faced a 22% to 25% higher readmission risk than those who did not receive LAIs (adjusted HR [aHR], 1.25; 95% CI, 1.21-1.30). Conversely, patients who received LAIs and did not discontinue them early experienced a 12% to 13% lower readmission risk than those without LAIs (aHR, 0.88; 95% CI, 0.84-0.92).

These results were consistent across different statistical models, including Cox proportional hazards and accelerated failure time models, after adjusting for potential confounding factors such as age, sex, prior antipsychotic use, and length of hospital stay.

According to the study authors, these findings provide valuable insights for clinicians and policymakers aiming to improve treatment outcomes for individuals with schizophrenia, advocating for greater utilization and adherence to LAIs during critical early phases of care.

The research contributes to the growing body of evidence supporting LAIs' efficacy but also calls for enhanced strategies to integrate these treatments more effectively into clinical practice, potentially reducing the burden of illness and improving long-term prognosis for this population.

"Our results suggest that maintaining consistent LAI treatment during the first admission for schizophrenia can substantially lower the risk of relapse and readmission,” the investigators concluded. “This underscores the need for clinicians to prioritize continuity of care and educate patients about the benefits of LAIs early in their treatment journey."

References

1. Chen W, Wu C, Liu C, et al. In-hospital use of long-acting injectable antipsychotics and readmission risk in patients with first-admission schizophrenia in Taiwan. JAMA Netw Open. 2024;7(6):e2417006. doi:10.1001/jamanetworkopen.2024.17006

2. Hennessey M, Son A, Oyekan E. Contributor: patient-centered approaches to supporting medication adherence among persons with schizophrenia. The American Journal of Managed Care^®. May 31, 2024. https://www.ajmc.com/view/contributor-patient-centered-approaches-to-supporting-medication-adherence-among-persons-with-schizophrenia