Release date 2024.9.9
In August 2024, Vita et al. reported the latest comparison of the efficacy and acceptability of long-acting injectable (LAI) antipsychotics in patients with acute schizophrenia spectrum disorders1).
The analysis included studies comparing LAI antipsychotics with placebo and oral antipsychotics, as well as studies comparing different LAI antipsychotics with each other.
The report showed the following order of efficacy, including oral antipsychotics:
- Oral Aripiprazole（Abilify）
- Aripiprazole LAI（Abilify Maintena）
- Oral Olanzapine（Zyprexa）
- lanzapine LAI（Zyprexa Relprevv）
- Risperidone LAI（Risperdal Consta）
- Paliperidone LAI（Invega Sustenna）
When considering acceptability, the results were as follows (Figure 1):
（Fig 1）Comparison of the Efficacy and Acceptability of Long-Acting Injectable Antipsychotics in Acute Schizophrenia Spectrum Disorders
At the two-week post-injection evaluation of efficacy for different LAI antipsychotics, the order of efficacy was as follows (Figure 2):
- Aripiprazole LAI（Abilify Maintena）
- Olanzapine LAI（Zyprexa Relprevv）
- Risperidone ISM（Risvan）
- Risperidone LAI（Risperdal Consta）
- Paliperidone LAI（Invega Sustenna）
- Aripiprazole Lauroxil（Aristada）
（Fig 2）Efficacy of Different Formulations of Long Acting Injectable Antipsychotics in Acute Schizophrenia Spectrum Disorders
About Risperidone ISM（Risvan）
Risperidone ISM is a new long-acting injectable formulation of risperidone, approved in the U.S. in April 2024.
It maintains both immediate and sustained drug levels in the blood and allows for a direct switch from oral medication to the injectable form2),3).
For patients with a history of taking oral risperidone and confirmed tolerability, the injectable can be administered from the first dose.
Additionally, while Risperdal Consta requires injections every two weeks, Risperidone ISM reduces the burden with injections once every four weeks.
About Aripiprazole Lauroxil（Aristada）
Aripiprazole Lauroxil is a prodrug of aripiprazole developed by Alkermes in the U.S. and approved in 2015.
One of its key features is that the injection interval can be adjusted to four, six, or eight weeks depending on the oral dose4).
A nano-crystal formulation that reaches effective blood levels in just one day has also been approved.
There are two initiation methods for switching to Aripiprazole Lauroxil: one involves taking the nano-crystal formulation and oral aripiprazole for one day before starting injections, and the other involves taking oral aripiprazole for 21 days before starting the injections. Both methods have demonstrated equivalent efficacy and safety5),6).
Rapid initiation of long-acting injectable formulations in the acute phase can help maintain adherence, reduce relapse rates, and ensure a better prognosis.
References
- 1） Vita G, et al.: Efficacy and acceptability of long-acting antipsychotics in acutely ill individuals with schizophrenia-spectrum disorders: A systematic review and network meta-analysis. Psychiatry Res, 340:116124, 2024.
- 2） Walling DP, et al.: The Steady-State Comparative Bioavailability of Intramuscular Risperidone ISM and Oral Risperidone: An Open-Label, One-Sequence Study. Drug Des Devel Ther, 15: 4371-4382, 2021.
- 3） Laveille C, et al.: Development of a population pharmacokinetic model for the novel long-acting injectable antipsychotic risperidone ISM. Br J Clin Pharmacol, 90: 2256-2270, 2024.
- 4） Maini K, et al.: Aripiprazole Lauroxil, a Novel Injectable Long-Acting Antipsychotic Treatment for Adults with Schizophrenia: A Comprehensive Review. Neurol Int, 13: 279-296, 2021.
- 5） Hard ML, et al.: Pharmacokinetic Evaluation of a 1-Day Treatment Initiation Option for Starting Long-Acting Aripiprazole Lauroxil for Schizophrenia. J Clin Psychopharmacol, 38: 435-441, 2018.
- 6） Sommi RW, et al.: Initiating Aripiprazole Lauroxil: Post Hoc Analysis of Safety and Tolerability of 1-Day and 21-Day Regimens. J Clin Psychiatry, 85: 23m15132, 2024.
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