REVIEW OF: Kane JM et al, JAMA Psychiatry 2020;77(12):1217–1224

STUDY TYPE: Randomized open-label controlled trial

We know that long-acting injectable antipsychotics (LAIs) can reduce the risk of relapse in patients with schizophrenia, but can LAIs also reduce the risk of first hospitalization in patients with early-phase schizophrenia? Inpatient psychiatric hospitalizations incur significant personal and economic burdens, so avoiding or extending the time to first hospitalization will meaningfully benefit our patients.

In this randomized, multicenter study, researchers compared the effect of aripiprazole once monthly (AOM) to treatment as usual (TAU) on time to first psychiatric hospitalization. Participants had a diagnosis of schizophrenia, were mostly men (75%) who were on average in their early 20s, and had less than five years of antipsychotic use. Nearly half the patients in both groups had one year or less of lifetime antipsychotic treatment. Researchers followed the AOM (n=234) and TAU (n=255) subjects for two years, contacting them by telephone every two months to assess for inpatient hospitalizations, which included overnight emergency department and crisis unit visits. 

Among the AOM subjects, 91% received at least one LAI dose during the study, compared to 51% of TAU subjects. Over nearly two years of follow-up, 39% of AOM subjects were hospitalized, in contrast to 61% of TAU subjects. AOM resulted in significantly increased time to first hospitalization (p=0.02): The average time to first hospitalization was 614 days for AOM subjects as compared with 531 days for TAU subjects. 

Of note, the study was funded by Lundbeck and Otsuka Pharmaceuticals. The authors state that the pharma company had no role in the study design, the data analysis, or the writing of the article.

Carlat Take

This study demonstrated that AOM appears to significantly delay the time to first hospitalization in young adults with schizophrenia. The results may have been even more pronounced had the use of LAIs in the TAU group not been so high. While it’s important to be cautious when drawing conclusions from pharma-funded research, the results are a good reminder to consider initiating LAIs early in the course of patients’ ­illness.