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Comparing LAI and Oral Antipsychotic Options: Expert Discussions with Schizophrenia Case Reports
Program Introduction
LAI antipsychotics are often initiated late in adults with schizophrenia, despite evidence supporting early use. Experts discuss the barriers to initiating LAI treatment, as well as adherence, efficacy and safety data.
Learning Objectives
After completing this educational activity, you should be able to:
- Examine data comparing the efficacy of LAIAs and oral medications.
- Analyze the clinical trial data and unique considerations of available LAIAs.
- Implement early integration of LAIA therapies in appropriate patients.
Target Audience
Psychiatrists and psychiatric NP/PAs
Program Description
On average, long-acting injectable antipsychotics (LAIAs) are often initiated late in adults with schizophrenia, despite evidence supporting early use. Leslie Citrome, MD, MPH, John Lauriello, MD, and Amber Hoberg PMHNP-BC discuss the latest guideline recommendations, benefits to early intervention services (EIS), barriers to initiating treatment with LAIAs, and compare efficacy and safety of LAIAs and oral medications in schizophrenia treatment. These data and considerations are then applied to real-world patient case studies as Drs Citrome and Lauriello and Amber determine the appropriate therapy for each patient, including their candidacy for treatment with LAIAs and how to switch from oral to LAI medication.
Support Statement
Supported by educational grants from Alkermes, Inc., Indivior, Inc., and Teva Pharmaceuticals.
Learning Objectives
After completing this educational activity, you should be able to:
- Examine data comparing the efficacy of LAIAs and oral medications.
- Analyze the clinical trial data and unique considerations of available LAIAs.
- Implement early integration of LAIA therapies in appropriate patients.
Release, Review, and Expiration Dates
This CME activity was published in April 2023 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2024.
Statement of Need and Purpose
The use of long-acting injectables (LAIs) can reduce healthcare costs by $18,314 PPPY by mitigating hospitalizations. Multiple studies have evaluated LAI antipsychotics versus oral antipsychotics in schizophrenia, although most studies were observational. These studies generally show a benefit for LAI antipsychotics versus oral drugs. Multiple studies have identified reductions in healthcare costs and the risk of hospitalization following transition of patients with schizophrenia from oral antipsychotic therapy to LAI therapy. LAIs were never discussed by a psychiatrist as an option for 50% of patients. In another survey of prescriber, patient, and caregiver perspectives regarding LAI antipsychotic therapy, LAIs as a therapeutic option were never discussed by psychiatrists in half of patients. Moreover, antipsychotic treatment decisions were made without patient or caregiver input 67% of psychiatrist-patient conversations. A survey of 379 schizophrenia-treating physicians discovered physicians are least confident transitioning to an injectable therapy. The study found that clinicians were most confident in determining when to initiate treatment and least confident in transitioning to injectable therapy or administering injectable therapy. Data supports the early use of LAIs, yet there is a lack of early LAI use.
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
© Copyright 2023 Physicians Postgraduate Press, Inc.
Faculty Affiliation
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Financial Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Ms. Hoberg is a consultant for Teva, Neurocrine. Has received speaker honoraria from Teva, Neurocrine, Intracellular Therapies, Avanir, Acadia, Axsome, and BioXcel. She has also received advisory board fees from Teva, Acadia, Intracellular Therapies, Sunovion and Neurocrine.
Dr. Lauriello is a consultant for Karuna Pharmaceuticals, Avanir Therapeutics, Teva and BioXcel.
Dr. Citrome is a consultant for AbbVie/Allergan, Acadia, Adamas, Alkermes, Angelini, Astellas, Avanir, Axsome, BioXcel, Boehringer Ingelheim, Cadent Therapeutics, Cerevel, Clinilabs, COMPASS, Eisai, Enteris BioPharma, HLS Therapeutics, Idorsia, INmune Bio, Impel, Intra-Cellular Therapies, Janssen, Karuna, Lundbeck, Lyndra, Medavante-ProPhase, Marvin, Merck, Mitsubishi-Tanabe Pharma, Neurocrine, Neurelis, Novartis, Noven, Otsuka, Ovid, Praxis, Recordati, Relmada, Reviva, Sage, Sunovion, Supernus, Teva. He is a stockshare holder for Bristol-Myers Squibb, Eli Lilly, J & J, Merck and has stock options for Reviva. He has received speaker honoraia from AbbVie/Allergan, Acadia, Alkermes, Angelini, Axsome, BioXcel, Eisai, Idorsia, Intra-Cellular Therapies, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Recordati, Sage, Sunovion, Takeda, and Teva. He has received publishing/royalty income from Royalties/Publishing Income: Taylor & Francis, Wiley, International Journal of Clinical Practice, UpToDate , Springer Healthcare, Elsevier.
None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation