# Long‐Acting Injectable Antipsychotic Use and Discontinuation Rates in Children and Adolescents With Schizophrenia Using Medicaid Claims Data

## TL;DR

This study examines how often long-acting injectable antipsychotics are prescribed and discontinued in children and teens with schizophrenia, finding racial differences in discontinuation rates.

## Contribution

The study is one of the first to analyze LAI antipsychotic use and discontinuation in pediatric Medicaid populations, highlighting racial disparities.

## Key findings

- LAI second-generation antipsychotics were prescribed in 94% of cases, with paliperidone palmitate and aripiprazole being the most common.
- Paliperidone palmitate was associated with a 46% lower discontinuation hazard for White compared to Black patients.
- Discontinuation rates did not differ between paliperidone and aripiprazole formulations when controlling for demographics.

## Abstract

The primary objective was to analyse the prescribing and discontinuation rates of long‐acting injectable (LAI) antipsychotics among child and adolescent populations. The secondary objective was to assess if racial/ethnic differences existed between LAI antipsychotics and discontinuation rates.

Children and adolescents (2–17 years old) with schizophrenia or related disorders who received LAI antipsychotics between January 1, 2017 and December 31, 2021 were identified using Merative MarketScan Multi‐State Medicaid Database. Descriptive statistics summarised the rates of LAI antipsychotic use. Kaplan–Meier survival curves were examined, and Cox regression analyses conducted to compare the hazard of discontinuation across LAI antipsychotics (p < 0.05).

A total of 1277 out of 67 502 patients were included in the final analysis. The average age was 15.4 ± 1.7 years (range 7–17 years). Approximately 59% were male, with the most common races identified being Black (48%) and White (38%). Prescribing of LAI second‐generation antipsychotics occurred in about 94% of the population. The most common LAI antipsychotics prescribed included paliperidone palmitate 1 month (40%) and aripiprazole formulations (48%). When controlling for age group, gender and plan type, the discontinuation rate for paliperidone and aripiprazole formulations did not differ. However, LAI paliperidone palmitate was associated with a 46% lower hazard of discontinuation for White compared to Black populations (HR = 0.54; p = 0.01).

Despite the limited sample, this study explored the frequency of prescribing and discontinuation rates between LAI antipsychotics in children. Future studies may further explain the unique challenges (e.g., reasons for discontinuation) and economic impact LAI antipsychotics present.