Key Takeaways
Extended Takeaways
- LAIs were rarely used at discharge in this hospitalized BD-I cohort: 76,608 (78.1%) received OA at discharge, while only 2,334 (2.4%) received LAI, highlighting a large practice gap despite observed short-term benefits.
- The strongest signal favored second-generation LAIs, which were associated with lower BD-I–related rehospitalization at 30 (3.6% vs 5.4%; P=.010), 60 (5.2% vs 7.5%; P=.008), and 90 (6.8% vs 9.1%; P =.015) days versus OAs.
- Hazard ratios suggest the benefit is front-loaded after discharge: for all LAIs, BD-I–related rehospitalization risk was lower at 30 (HR: 0.784; 95% CI: 0.626–0.981) and 60 days (HR: 0.818; 95% CI: 0.680–0.984), but not statistically significant at 90 days (HR: 0.856; 95% CI: 0.726–1.011).
- Absolute risk reductions were modest but potentially meaningful in high-risk patients: at 30 days, the ARR for all LAIs was 1.1% (yielding a number needed to treat [NNT] of approximately 91), while SG LAIs showed an ARR of 1.8% (NNT of approximately 56); by 60 days, the ARR for SG LAIs increased to 2.3% (NNT=43).
- Rehospitalization length of stay was not materially different by formulation, suggesting the main advantage of LAIs in this study was preventing readmission rather than shortening subsequent admissions.
- Medication persistence after relapse was poor among LAI-treated patients: 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, which may represent a target for postdischarge treatment review.
