Clinical Summary
Clinical Summary: Outcomes and Practice Patterns of Long-Acting Injectable Versus Oral Antipsychotics Among Patients With Bipolar I Disorder in the United States: A Hospital Database Analysis
Patients with bipolar I disorder are frequently rehospitalized after discharge, and poor adherence to oral antipsychotics is a persistent clinical barrier. This study addresses whether long-acting injectable antipsychotics are associated with fewer early readmissions in real-world US hospital practice, where their use remains uncommon.
Design
This retrospective cohort study was conducted using the Premier Hospital database between October 2020 and September 2023.
N
Of 98,088 eligible patients
Population
Eligible patients were aged ≥18 years with a primary or admitting diagnosis of BD-I (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] diagnosis code of F31.0, F31.8, or F31.9) and had data available ≥3 months pre index date (baseline) and ≥3 months post index date (follow-up) during the study period.
Duration
between October 2020 and September 2023
Key Findings
- BD-I–related rehospitalization rates were lower for the LAI group than for the OA group within 30 (3.9% vs 5.0%; P=.033) and 60 days (5.9% vs 7.2%; P= .030), while the 90-day difference did not reach statistical significance (7.4% vs 8.5%; P =.064).
- Patients in the LAI group were at lower risk of BD-I–related rehospitalization within 30 (HR: 0.784; 95% CI: 0.626–0.981) and 60 days (HR: 0.818; 95% CI: 0.680–0.984) compared to the OA group; the 90-day result was not statistically significant (HR: 0.856; 95% CI: 0.726–1.011).
- The SG LAI subgroup had lower BD-I–related rehospitalization than the OA group within 30 (3.6% vs 5.4%; P=.010), 60 (5.2% vs 7.5%; P=.008), and 90 days (6.8% vs 9.1%; P =.015).
- Patients in the SG LAI subgroup had a lower risk of rehospitalization within 30 (HR: 0.653; 95% CI: 0.469–0.909), 60 (HR: 0.692; 95% CI: 0.526–0.911), and 90 days (HR: 0.742; 95% CI: 0.582–0.945) than patients in the OA group.
- LAIs were rarely used at discharge: of 98,088 eligible patients, 76,608 (78.1%) received OA at discharge, while 2,334 (2.4%) of all eligible patients received LAI; among those discharged on LAIs, only 38.9%–41.4% continued with LAI treatment at rehospitalization within 30–90 days.
Clinical Bottom Line
For hospitalized patients with bipolar I disorder, long-acting injectable antipsychotics—especially second-generation formulations—were associated with fewer early BD-I–related rehospitalizations than oral antipsychotics. The main clinical value appears to be in preventing short-term readmission after discharge, not shortening later hospital stays.
Practice Implications
- Consider an LAI during discharge planning for patients with BD-I who have poor adherence, recent relapse, or high early readmission risk, given lower BD-I–related rehospitalization at 30 and 60 days and lower risk with SG LAIs through 90 days.
- Do not assume LAIs are already being used when indicated: only 2,334 (2.4%) of all eligible patients received LAI, despite lower early BD-I–related rehospitalization versus OAs.
- Review treatment continuation carefully after relapse or rehospitalization, because only 38.9%–41.4% of those discharged on LAIs and 35.4%–37.0% of those discharged on SG LAIs remained on an LAI at rehospitalization within 30–90 days.
- Set expectations that benefit is modest in absolute terms but potentially meaningful in high-risk patients: at 30 days, the ARR for all LAIs was 1.1% and for SG LAIs was 1.8%; by 60 days, the ARR for SG LAIs increased to 2.3% (NNT=43).
