# Real-world examination of the rates of long-acting injectable attrition in a cohort of early psychosis patients after discharge from an early intervention service for psychosis

## TL;DR

The study found that most early psychosis patients continue using long-acting injectable antipsychotics for two years after leaving specialized treatment programs.

## Contribution

This study provides real-world evidence of long-term LAI adherence in early psychosis patients post-discharge from early intervention services.

## Key findings

- 71% of patients remained on LAI medications 24 months after discharge.
- Aripiprazole was the most commonly used LAI, with most patients staying on the same formulation.
- Patients who continued LAI had significantly reduced rehospitalization rates compared to those who discontinued.

## Abstract

Patients treated in early intervention for psychosis programs have better treatment outcomes and higher rates of long-acting injection (LAI) antipsychotic medication utilization (20%–50%) versus treatment as usual. These programs usually serve patients for 2–3 years, then most patients are discharged to other mental health services and studies of patients with longer-standing schizophrenia suggest switching to oral medications may be common. However, following patients post-discharge is complicated by the challenges of migrated patient records across clinical services and providers.

To examine whether LAI use continues after discharge from an early intervention service for psychosis.

This study was a retrospective cohort study examining the effects of continuation or discontinuation of LAI therapy in individuals who have completed treatment in an early intervention service (EIS) for psychosis.

A retrospective cohort was created from a group of individuals discharged from EIS for psychosis over a 3-year period from January 1, 2016 to December 31, 2018 and followed for mental health outcomes and antipsychotic medications prescribed for a subsequent 2-year period at discharge, 6, 12, 18, and 24 months post-discharge.

Of 85 subjects discharged from three sites in three different provinces in Canada for whom full follow-up could be recorded, 60 subjects remained on LAI medications after 24 months (71%). The average age of the cohort was 22 years (SD 4.7) at admission to an EIS. At discharge, the most commonly used LAI was aripiprazole, and most subjects were maintained on the same formulation at 24 months, if still on LAI. Reasons for discontinuation were predominantly patient preference. Significant differences in clinical outcomes, measured through reduced rehospitalization were seen for those who remained on LAI as compared to those who did not.

LAI adherence is still strong 24 months after discharge from an EIS for psychosis.

Examination of the use of long acting injectable (LAI) antipsychotic medications in early psychosis patients after discharge from an early intervention service for psychosis

Why was this study done? Patients who are treated in early intervention medical services for psychosis (EIS) have better treatment outcomes. Patients in these programs also have higher rates of long-acting injection antipsychotic (LAI) medication prescriptions (20-50%) compared to treatment by regular psychiatrists. EIS usually serve patients for 2-3 years, and then most patients are discharged to other mental health services. After moving to a new treatment program, some studies have shown that patients with chronic illness switch to oral/pill medications instead of injections. However, following mental health patients over time is complicated by the challenges of following patient records across different hospitals and doctors. How was the study done? We set out to collect data on a group of patients that had left an early intervention service and were using LAI medications. We followed their care for two years after discharge to see if these patients stayed on LAIs with their new doctors. What did the study find? We found that of 85 subjects discharged from 3 sites in 3 different provinces in Canada for whom all medical records could be found, 60 patients remained on LAI medications after 24 months (71%). The average age of the patients was 22 years (SD 4.7) at admission to an EIS. At discharge the most commonly used LAI was aripiprazole and most patients stayed on this same drug for the full 24 months. We recorded reasons for stopping LAIs and found that stopping was usually from the patient’s request. We found a significant benefit through reduced rehospitalization for were seen for those who remained on LAI as compared to those who did not. What does this mean? The take away message from this study is that LAI use is still strong 24 months after discharge from an EIS for psychosis.