Tweetorial: Reviewing LAI vs. Oral Data in the Treatment of Schizophrenia

The content for this activity is available here on Twitter


Experts compare data on hospitalization, adherence, relapse risk, tolerance and efficacy between LAIs and OAs in the treatment of schizophrenia. 

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

Despite evidence supporting early use of long-acting injectable (LAI) antipsychotics in adults with schizophrenia, LAIs are often initiated late in the course of treatment. This Tweetorial summarizes the key points of discussion between Leslie Citrome, MD, MPH, John Lauriello, MD, and Amber Hoberg, PMHNP-BC comparing data between LAI and OA use in adults with schizophrenia, including hospitalization rates, adherence, relapse risk, and clinical trials. The experts discuss the remaining barriers to implementing LAI treatment, and how to initiate LAI treatment in real-world practice.  

Additional Information

Activity summary
Available credit: 
  • 0.25 AMA PRA Category 1 Credit™
  • 0.25 Participation
Activity opens: 
Activity expires: 

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

Photo of John Lauriello
John Lauriello, MD 
Professor and Chair of Psychiatry
and Human Behavior
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania 

Photo of Leslie Citrome
Leslie Citrome, MD, MPH  
Clinical Professor of Psychiatry
and Behavioral Sciences 
New York Medical College
Valhalla, New York

Photo of Ann Hoberg
Amber R Hoberg, PMHNP-BC 
Psychiatric Nurse Practitioner
Morning Star Family Medicine
San Antonio, Texas 

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 0.25 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 Evaluation.

Available Credit

  • 0.25 AMA PRA Category 1 Credit™
  • 0.25 Participation


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