Clinical Summary: Latency to Long-Acting Injectable Antipsychotic Initiation and Psychiatric Hospitalization in First-Episode Schizophrenia
Relapse and rehospitalization remain major consequences of poor antipsychotic adherence in schizophrenia, yet clinicians still lack a clear answer on when to start a long-acting injectable in the early course of illness. This study addresses a practical question in newly diagnosed schizophrenia: whether delaying LAI initiation changes hospitalization burden and treatment persistence in routine care.
Key Findings
- Among 6,380 patients, 30.5% were initiated on LAI treatment within the first year after diagnosis.
- Compared to those who commenced LAI antipsychotics within 1 year, the hazard ratios for treatment discontinuation were significantly lower among patients who were initiated at 2–3 years (HR =0.774; 95% confidence interval [CI], 0.692–0.866; P<.001), 3–4 years (HR=0.768; 95% CI, 0.682–0.864; P<.001), 4–5 years (HR=0.698; 95% CI, 0.613–0.794; P5 years (HR =0.657; 95% CI, 0.586–0.736; P<.001) after diagnosis.
- In the full cohort (N=6,380), patients who were initiated on LAIs >5 years after diagnosis had significantly higher hospitalization-day ratios compared to those initiated within 1 year (model 1: β=0.024, t=2.87, P =.004).
- Within the >5-year group, a longer delay to LAI initiation was also associated with increased hospitalization burden (model 2: β=3.69×10−5, t=2.53, P=.011).
- In the subgroup of patients with a history of psychiatric hospitalization during the LAI treatment period (N=2,109), patients who were initiated on LAIs at 1–2 years (β=0.039, t=2.06, P=.039), 3–4 years (β=0.057, t=2.57, P=.010), and >5 years (β=0.162, t =7.71, P <.001) had significantly higher hospitalization-day ratios than those initiated within <1 year.
For patients with newly diagnosed schizophrenia who go on to receive continuous LAI treatment, starting an LAI within the first year is linked to fewer psychiatric hospitalization days than waiting until >5 years after diagnosis. Later initiation is associated with better treatment persistence, but that advantage does not offset the higher hospitalization burden seen with delayed use.
Practice Implications
- Consider discussing LAI treatment early in the course of schizophrenia rather than reserving it only for chronic illness, because initiation within 1 year was associated with fewer hospitalization days than initiation >5 years after diagnosis.
- If a patient has ongoing illness severity or psychiatric hospitalization during LAI treatment, avoid prolonged delay in LAI initiation; in this subgroup, hospitalization-day ratios were significantly higher with initiation at 1–2 years, 3–4 years, and >5 years versus <1 year.
- Set expectations that earlier LAI initiation was associated with higher discontinuation risk than later initiation, with lower discontinuation hazards emerging after 2 years, so adherence counseling and follow-up are especially important when starting LAIs early.
- Do not assume LAIs have lost value after chronic illness is established; even in the >5-year group, longer delays to initiation were associated with greater hospitalization burden (β=3.69×10−5, t=2.53, P=.011).
