[Studying the Efficacy of Long-acting Injectable Antipsychotics (LAI) While Considering Study Design Limitations : A Discussion in Favor of LAI].

Abstract

This article was adapted from the presentation of a debate session at the 111th annual meeting of the Japanese Society of Psychiatry and Neurology. It addresses the pros and cons of long-acting injectable antipsychotics (LAI), and the author of this article suppored the use of LAIs on the basis of their efficacy. Based on randomized controlled trials (RCTs), LAIs were similar to oral antipsychotics in terms of relapse prevention. However, in the RCTs, selection bias and alterations in treatment ecology have to be taken into consideration, in that patients in the RCTs are more likely to be adherent. For example, various treatment experiences in RCTs, such as reminders, assessments, and/or incentives, could have improved patients' adher- ence. In contrast, mirror image studies, which compare the equivalent duration before and after the initiation of a new treatment, may reflect the effectiveness of LAIs in real-world clini- cal settings. In mirror image studies, the hospitalization risk and rate significantly decreased after the introduction of LAIs. LAIs as a treatment option should be discussed with patients, especially those who have adherence problems and/or who prefer LAIs.