Long-Acting Injections Reduce Hospital Admissions, UK

Main Category: Schizophrenia
Also Included In: Psychology / Psychiatry
Article Date: 12 Mar 2008 - 1:00 PDT

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A new UK study published in the Journal of Psychopharmacology shows that the number of hospital admissions for people diagnosed with schizophrenia is significantly reduced following the initiation of treatment with risperidone long-acting injections (risperidone LAI)1. The study investigators concluded the results are significant since re-admission to hospitals is a strong indicator for relapse in people suffering from the disease1.

"For many people, relapse can be a result of non-adherence to antipsychotic medication and this study suggests that long-acting injections of antipsychotic medication may help break this cycle" said Dr Mark Taylor, the lead investigator of the study from the Spring Park Centre, Glasgow. "Long-acting injections with an atypical antipsychotic are a significant step forward in the management of schizophrenia. The data also suggests that by ensuring people receive appropriate medication there may be an economic advantage for the NHS by reducing the number of admissions to hospital."

The study examined records for 100 schizophrenia patients who had completed 12 months of risperidone LAI, of which 67 were initiated as outpatients and 33 as inpatients, with ages ranging from 19 to 70 years (median 41 years). The data collected showed patient history 12 months before and after starting risperidone LAI treatment1. The study aimed to quantify the impact of risperidone LAI on psychiatric secondary care utilisation in patients with schizophrenia or schizophrenic disorders by looking at the number of hospitalisations and bed days in the 12 months before and after initiation of risperidone LAI treatment1.

All patients studied were switched to risperidone LAI from other medications due to side effects, a lack of efficacy, poor compliance, patient preference or a combination of these reasons1. Of all the cases switched to risperidone LAI, 45% of them listed poor compliance as a factor indicating that this is a significant issue in the management of schizophrenia1.

The results show that in the 12 months following initiation of risperidone LAI, a significant reduction in hospital admissions was reported compared to the 12-month period before starting treatment with risperidone LAI (0.62 vs 0.24 admissions per person-year available for admission, respectively, p<0.01)1.

The change in total number of bed days between the 12 months pre- and post- risperidone LAI initiation periods increased from 4310 to 4370. However, the authors postulate this may be attributed to the 33 patients who initiated risperidone LAI treatment as inpatients. The clinical deterioration experienced by these patients prior to treatment may have impacted the pre- and post- bed day analysis. This is supported by the significant difference in number of bed days seen in those patients initiated on risperidone LAI as outpatients, pre- and post- risperidone LAI treatment (1363 and 363, respectively, p<0.001)1.

Overall it was concluded that the number of hospital admissions is a more reliable indicator of the impact of treatment than the total number of bed days in this type of study1. The number of reduced hospital admissions observed in this study, following risperidone LAI treatment initiation, is important to note since re-admission to hospital is a good proxy measure of relapse and adherence is a key factor in relapse prevention1.

Admissions per person year: The results for hospitalisations have been presented as hospitalisations per patient-years available for admission to take account of potential bias related to the proportion of time that the 33 inpatients were not available for admission (i.e. the duration of inpatient stay following RLAI initiation).

Janssen-Cilag Ltd (http://www.janssen-cilag.co.uk), manufacturer of Risperdal® Consta™ (http://www.risperdal-consta.co.uk), Risperdal™ (risperidone), Risperdal® Quicklet™ and Invega® is part of the Johnson & Johnson family of companies, a leading research-based pharmaceutical company, with more than 110,000 employees worldwide and establishments in approximately 50 countries.

Symptoms of schizophrenia include hearing voices, hallucinations and delusions, apathy, social withdrawal and a lack of emotional expression.

References:

1. Taylor M, Currie A, Lloyd K, et al. The impact of risperidone long acting injection on resource utilisation in psychiatric secondary care. J Psychopharmacol. March 2008 : 128-131

http://www.janssen-cilag.co.uk