Barnett Joshua, Pappa Sofia
West London NHS Trust, London, UK.
East London NHS Foundation Trust, London, UK.
Schizophrenia (Heidelb). 2025 Jun 23;11(1):92. doi: 10.1038/s41537-025-00637-7.
Relapses are frequent in schizophrenia and other psychotic disorders. While long-acting injectable antipsychotics (LAIs) are effective in preventing hospital admissions and improving adherence and patient outcomes, they are still under-utilised. Furthermore, evidence from newer formulations and longitudinal studies, despite their commonly long-term use, remains limited. To address this scarcity of data, this study aims to evaluate the long-term effectiveness and acceptability of once-monthly Aripiprazole long-acting injectable (ALAI), the only third-generation antipsychotic available in long-acting formulation. In this pragmatic, independent, ten-year mirror-image study conducted within a large urban mental health service in London, UK, we assessed hospital admission rates and treatment retention over 5 years following ALAI initiation in a naturalistic adult cohort. Frequency and length of hospitalisations in the 5 years pre- and post-initiation were recorded using electronic records, as were discontinuation rates and reasons. Separate analyses were performed comparing outcomes between treatment completers and discontinuers, as well as between those with schizophrenia vs other diagnoses. In total, 135 patients were included in the study (63% with Schizophrenia, 37% with other diagnoses). The discontinuation rate was 47% at 5 years (23.7%, 13.6%, 7.9%, 7.3% and 5.3% in years 1 to 5 respectively). Among the 53% who completed 5 years of ALAI treatment, we observed an 88.5% reduction in mean number (1.57 to 0.18, p < 0.001) and a 90% reduction in mean length of hospitalizations compared to 5 years pre-ALAI initiation (103 to 10 days, p < 0.0001). Median admissions and length fell from 1 to 0 and 68 to 0 days (p < 0.001), respectively. In contrast, discontinuers (47%) exhibited inferior outcomes and showed only a 29.9% reduction in admissions over 5 years. Patients were more likely to discontinue due to poor compliance and ineffectiveness and rarely due to tolerability issues. Apart from switching to ALAI from another LAI, there were no major clinical or demographic predictors of treatment continuation. Outcomes were consistent independent of diagnosis. Potential confounders however must not be overlooked, such as the exclusion of a large number of patients due to strict eligibility criteria as well as changes to healthcare policy over the study period. This is the first study to report 5-year hospitalisation and treatment persistence outcomes with ALAI. Its sustained use was associated with substantial reductions in hospital use, with 85% of completers requiring no further admissions, compared to 30% of discontinuers. These real-world findings support the long-term value of ALAI and may help address common barriers to LAI adoption in clinical decision-making.
精神分裂症和其他精神障碍的复发很常见。虽然长效注射用抗精神病药物（LAIs）在预防住院、提高依从性和改善患者预后方面有效，但它们的使用仍然不足。此外，尽管新型制剂和纵向研究通常长期使用，但其证据仍然有限。为了解决数据稀缺问题，本研究旨在评估每月一次的阿立哌唑长效注射剂（ALAI）的长期有效性和可接受性，它是唯一有长效制剂的第三代抗精神病药物。在英国伦敦一家大型城市心理健康服务机构进行的这项务实、独立的十年镜像研究中，我们评估了一个自然主义的成年队列在开始使用ALAI后5年内的住院率和治疗保留率。使用电子记录记录开始使用前和开始使用后5年的住院频率和时长，以及停药率和停药原因。分别进行分析，比较治疗完成者和停药者之间以及精神分裂症患者与其他诊断患者之间的结果。该研究共纳入135名患者（63%为精神分裂症患者，37%为其他诊断患者）。5年时的停药率为47%（第1至5年分别为23.7%、13.6%、7.9%、7.3%和5.3%）。在完成5年ALAI治疗的53%的患者中，我们观察到与开始使用ALAI前5年相比，平均住院次数减少了88.5%（从1.57次降至0.18次，p<0.001），平均住院时长减少了90%（从103天降至10天，p<0.0001）。住院次数中位数和住院时长中位数分别从1次降至0次和从68天降至0天（p<0.001）。相比之下，停药者（47%）的结果较差，5年内住院次数仅减少了29.9%。患者更有可能因依从性差和无效而停药，很少因耐受性问题停药。除了从另一种长效注射剂改用ALAI外，没有主要的临床或人口统计学因素可预测治疗的持续情况。无论诊断如何，结果都是一致的。然而，潜在的混杂因素不容忽视，例如由于严格的纳入标准排除了大量患者，以及在研究期间医疗政策的变化。这是第一项报告使用ALAI 5年住院和治疗持续结果的研究。其持续使用与住院次数大幅减少相关，85%的完成治疗者无需进一步住院，而停药者这一比例为30%。这些真实世界的研究结果支持了ALAI的长期价值，并可能有助于解决临床决策中采用长效注射剂的常见障碍。
