Key Takeaways

From the Authors As published in the article
  1. Second-generation long-acting injectable antipsychotic initiation in bipolar disorder was associated with less acute-care use and greater engagement in planned outpatient care.
  2. Scheduled injection visits may promote clinical monitoring and continuity of care beyond medication delivery alone.
  3. Stable use reflects sustained engagement with long-acting injectable–based care and should not be interpreted as head-to-head evidence of superior pharmacologic efficacy.
Extended Takeaways
  1. Only 500 of 2,919 bipolar disorder initiators met the study’s definition of stable use, underscoring that maintaining label-frequency-concordant long-acting injectable antipsychotic care over 12 months may be a major implementation challenge in routine practice.
  2. The study used formulation-specific persistence thresholds, so clinicians interpreting “stable use” should note that it meant at least 12 injections for Abilify Maintena and Invega Sustenna, at least 24 injections for Risperdal Consta, and at least 4 injections for Invega Trinza during the first postindex year.
  3. Among stable users, the largest measurable tradeoff was higher outpatient spending alongside lower inpatient burden: outpatient drug costs rose from US$356.16 to US$2,860.08, while inpatient medical expenditures fell from US$7,405.35 to US$3,767.12.
  4. Short-term budget expectations should remain cautious, because total medical costs did not significantly decline in stable users despite reduced acute-care use, changing from US$8,112.19 to US$7,394.73 (P =.188), while total drug costs increased from US$1,405.48 to US$3,631.88 (P < .001).
  5. The sensitivity analysis is clinically important for avoiding overinterpretation: when the ±30-day index window was excluded, the apparent postinitiation reductions in inpatient admissions, length of stay, and inpatient expenditures among non-stable users were no longer robust.
  6. Long-acting injectable uptake expanded substantially in Taiwan over the decade, with the proportion of LAI users among all treated users rising from 4.8% in 2014 to 10.2% in 2024 and the share of SGA-LAI users among all LAI users increasing from 55.7% to 91.2%.
Read full article
Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

Insightful. Evidence-based. Human-centered.

Listen Now
Psychiatrist Steven Berkowitz, MD, discusses psychedelic medicine for trauma treatment

Subscribe to read
more articles

Subscribe