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LAI Antipsychotics at Discharge Associated With Sharp Decline in Readmissions
Long-acting injectable (LAI) antipsychotics upon hospital discharge were linked with 75% fewer 30-day rehospitalizations compared with oral antipsychotics in patients with schizophrenia or schizoaffective disorder, according to results from a single-center study published in the Journal of Clinical Psychopharmacology.
“Controlling symptoms to avoid hospitalization is even more important with schizophrenia than other conditions because each relapse makes the condition harder to treat going forward,” said study corresponding author Daniel Greer, PharmD, BCPP, a clinical assistant professor at the Rutgers University Ernest Mario School of Pharmacy, Piscataway, New Jersey.
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The retrospective review compared 30-day readmission rates for all patients with schizophrenia or schizoaffective disorder discharged from a single academic hospital between August 2019 and June 2022. Among a total 343 patients, 240 chose oral antipsychotics and 103 chose LAI antipsychotics.
According to the study, 30-day hospital readmission rates were 1.9% for the LAI antipsychotic group compared with 8.3% for the oral antipsychotic group.
“I suspect the lower readmission rate that has been observed with long-acting injections has more to do with people forgetting to take a pill each and every day than with any inherent superiority of the injectable medication,” Dr Greer said.
Average chlorpromazine equivalent antipsychotic doses were 477.3 mg per day among patients discharged on LAI antipsychotics compared with 278.6 mg per day among patients discharged on oral antipsychotics, the study found. The prevalence of medication to treat extrapyramidal symptoms was 22.3% in the LAI antipsychotic group and 30.8% in the oral antipsychotic group.
Nearly two-thirds of the LAI antipsychotics used were from pharmaceutical company hospital inpatient free trial programs, researchers reported.
Although many insurers have historically refused to cover LAI antipsychotics due to cost, growing evidence supporting their superior outcomes has led to improvements in insurance coverage, Dr Greer said.
“The cost of the injections is far lower than the cost of hospital treatments,” he said. “And each additional visit to the hospital increases the odds that there will be more visits in the future. Every time someone experiences psychosis, they lose gray matter, and they suffer damage that never heals. That’s why it’s so vital to minimize psychotic episodes.”
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