Key Takeaways
Extended Takeaways
- In this cohort restricted to patients who achieved continuous LAI treatment, only 30.5% started an LAI within the first year after diagnosis, indicating that early use remained uncommon despite a decade-long shift toward earlier prescribing.
- Later LAI initiation was linked to lower discontinuation risk: compared with initiation within 1 year, hazard ratios were significantly lower 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).
- Among patients who had psychiatric hospitalization during LAI treatment, the association between delayed initiation and hospitalization burden was stronger: relative to the 5 years (β=0.162, t =7.71, P <.001).
- Even within timing strata, added delay sometimes mattered: in hospitalized patients, longer time to LAI initiation was associated with higher hospitalization burden in the 5-year (β=1.87×10−4, t=4.96, P<.001) groups.
- Prescribing patterns were dominated by newer agents, with paliperidone palmitate 1-month formulation accounting for 76.9% of initial LAI prescriptions in 2011 and 65.2% in 2020, while aripiprazole monohydrate rose from 19.8% in 2011 to 43.5% in 2017 before declining to 33.8% in 2020.
- Mean time from diagnosis to LAI initiation fell markedly from 1,980.8 days (SD=1,095.4) in 2011 to 133.4 days (SD=127.6) in 2020, but mean continuous LAI treatment duration also dropped from 646.1 days (SD=736.9) to 246.4 days (SD=140.0), suggesting earlier adoption has not translated into longer maintenance exposure.
