LAIs for Schizophrenia: Misconceptions and the Future of the Treatment

In this video, Sanjai Rao, MD, DFAPA, Associate Clinical Professor of Psychiatry, Associate Residency Training Director, University of California, San Diego, discusses common misconceptions surrounding long-acting injectables (LAIs) and the future of the schizophrenia treatment option.

Dr Rao recently spoke in a Psych Congress Elevate session titled “Clinical Profile and Considerations for Use of a Long-Acting Injectable Treatment in Adults With Schizophrenia” and he shares more insights on this topic here:

LAIs Offer Opportunity for Increased Medication Adherence in Patients With Schizophrenia

Effective Communication Strategies to Implement LAIs Into Treatment Plans
 

Read the transcript:

One of the biggest misconceptions I see comes not just from patients but also from physicians. That's this idea that when you inject a large quantity of an LAI into someone, isn't that dangerous, because you're giving them too much medication, and what happens if that goes horribly wrong? The way that I answered this is as follows.

I say, "Well, when you give patients a prescription for whatever medication you're giving them, do you give them a prescription for one day at a time or do you give them a prescription for one month at a time? Obviously, you don't give them a prescription for one day at a time. You give it to them for a month at a time or even three months at a time."

Then, I say "OK, so you're OK with the patient taking home a 30 day-supply of an antipsychotic medication that they then could take any which way that they want.

"You're trusting them to take it once a day every day in the exact amount, but you're completely OK with them having the entire month's supply to do with as they wish. If you are, then what are you so worried about an LAI?"

All you're doing with an LAI is you're taking that months' worth of medication, the pill bottle, and you're basically implanting the pill bottle into one of their muscle groups, their arm or their glute, and then you're letting the body deal with the day-to-day administration.

You're not getting any more medication. You're getting the same day-to-day amount of medication, except this time, it's automatic and it's much more gentle. It doesn't rely on the patient doing it correctly, because their body already knows how to do it correctly.

Unless you want to have someone come back every day for medication as an oral medication, you're already OK with them having a month's supply of medication. This is just the difference in where that month's supply is going and how it's being dispensed.

The future of LAI treatment. I'll tell you where I'd like it to head, because it's hard to predict where it will head. Where I'd like it to head is that it becomes a much more accepted part of our practice, and that's not unrealistic.

It's not unrealistic, because in other parts of the world, it already is a much more accepted part of practice. If you look at most of the countries in the European Union, something like 30 to 50 percent of their schizophrenia patients are on an LAI.

It depends on which country, but the low number's around 30 and the high number's around 50. You compare that to the United States and we've been hovering around 12 to 15 percent for a long period of time. There's not that much difference between us and them.

If there are 30 to 50 percent, there's no reason we couldn't be. That would make a material change in our treatment of schizophrenia. If we could get a third or a half of our patients on LAIs, that's a huge difference from where we are right now, and there's a realistic path to it.

I don't want anything I've said to suggest that everybody can be on an LAI or that you should expect 100 percent of patients to be on an LAI. There's a very realistic path to getting 30 to 50 percent of our patients on LAIs.

That's realistic and that would make a huge difference in the care that we provide.

Dr Sanjai Rao is an Associate Clinical Professor of Psychiatry and Associate Residency Training Director at the University of California, San Diego (UCSD), and the Site Director for Residency Training at the VA Medical Center in San Diego, CA.  A lifelong clinician educator, Dr Rao’s clinical practice is focused on inpatient and acute care at the VA, with an emphasis on teaching practical psychopharmacology to the many trainees he supervises. Dr. Rao coordinates the UCSD Psychiatry Residency curriculum and has received a number of teaching awards based on his clinical and academic work, including the APA Irma Bland Award for Excellence in Residency Teaching.

Dr. Rao received his undergraduate degree from Stanford University, California, his medical degree from the University of California, San Diego, completed his residency at UCSD, and is board certified in general psychiatry and consult-liaison psychiatry. He is also the Immediate Past President of the San Diego Psychiatric Society and an APA Distinguished Fellow.