# A Multicentre, 4‐Year Mirror‐Image Study Comparing the Effectiveness of Long‐Acting Injectable Antipsychotics in the Treatment of Bipolar Disorder: Results From the LAICO Study

## TL;DR

A 4-year study compared long-acting injectable antipsychotics for bipolar disorder, finding that paliperidone palmitate (3-monthly) led to better outcomes with fewer hospitalizations.

## Contribution

This study provides real-world evidence comparing different long-acting injectable antipsychotics for bipolar disorder, focusing on treatment retention and hospitalization rates.

## Key findings

- PP3M was associated with significantly lower risk of hospitalization compared to A1M, PP1M, and R-LAI.
- Study completers showed a 79% reduction in hospital admissions and 83% reduction in bed days compared to non-completers.
- Risperidone-LAI had the shortest time to discontinuation and first hospitalization.

## Abstract

This was a 4‐year mirror‐image study of adult patients diagnosed with bipolar disorder (BD) assessing the effects on treatment continuation and hospitalisation between aripiprazole 1‐month (A1M), risperidone‐LAI (R‐LAI) and the monthly and 3‐monthly formulations of paliperidone palmitate (PP1M, PP3M). We aimed to evaluate and compare the use of A1M, R‐LAI, and the monthly and 3‐monthly formulations of paliperidone palmitate (PP1M, PP3M) by using the change of number and length of hospitalisations 2 years before compared to 2 years after initiation of LAIs for continuers and discontinuers. Secondary outcomes were: (1) discontinuation rates at 2 years and reasons per LAI, (2) time to discontinuation per LAI, and (3) time to first hospitalisation per LAI.

A total of 122 BD were included; 74 continued LAI treatment at two years. Reasons for discontinuation were poor compliance (50%), ineffectiveness (43.2%), and tolerability issues (13.6%). Both time to individual LAI discontinuation and time to first hospital admission were significantly lower in the R‐LAI group. There was a significant overall reduction in the number and length of hospitalisations two years before and after LAI initiation, although multivariate logistic regression analysis showed that A1M, PP1M and R‐LAI were associated with an increased risk (OR = 1.89, 95% CI = 1.54–3.68, p = 0.015; OR = 1.63, 95% CI = 1.29–2.77, p = 0.022; OR = 3.08, 95% CI = 1.48–6.05, p = 0.008, respectively) of bed usage compared to PP3M. Last, study completers showed a considerable drop of 79% in number of hospital admissions and 83% in bed days (p = 0.001) as opposed to non‐completers.

Study findings suggest that long‐acting antipsychotics such as A1M, PP1M, and particularly PP3M are associated with high retention and lower hospitalisation rates after 2 years of treatment in patients with BD.