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Management of Schizophrenia

Defining the Role of Long-Acting Injectable Risperidone

  • Drugs in Disease Management
  • Published:
Disease Management & Health Outcomes

Abstract

Schizophrenia is a chronic disease that typically manifests during adolescence and early adulthood. Treatment of this disease consumes a significant proportion of the healthcare budget (billions of dollars in the US). Primary management options for schizophrenia include both pharmacologic and psychosocial interventions, with antipsychotic therapy (typicals or atypicals) being the mainstay of any treatment plan. Atypical agents are recommended in current guidelines as first-line treatments for patients with newly diagnosed schizophrenia. The newer atypical antipsychotic agents have a lower propensity to cause extrapyramidal symptoms and tardive dyskinesia, and are at least as effective as typical agents.

Long-acting injectable formulations of antipsychotic drugs help to ensure drug delivery and are recommended in patients who are partially or fully noncompliant, or who prefer this formulation. The goal of using these agents is to reduce noncompliance, thus reducing the likelihood of relapse and/or hospitalization, and ultimately reducing treatment costs. Benefits associated with long-acting formulations include the maintenance of stable plasma concentrations, the reduction of overdose risks, and the establishment of regular contact between the patient and their healthcare provider. Currently, risperidone is the only atypical agent available as a long-acting injectable formulation.

In patients with schizophrenia, long-acting injectable risperidone (25–50mg every 2 weeks) is no less effective than once-daily oral risperidone, has superior efficacy to placebo over the short term, and significantly improves symptoms over the long term in patients who are symptomatically stable at baseline. Long-acting injectable risperidone is well tolerated and has a tolerability profile similar to that of oral risperidone, apart from injection-site reactions, which are generally mild and transient. This formulation of risperidone reduces the incidence of hospitalization and significantly improves health-related quality of life (HR-QOL; in particular mental health-related domains) in patients with symptomatically stable schizophrenia. Pharmacoeconomic models have indicated that long-acting injectable risperidone — relative to oral risperidone, oral olanzapine, or long-acting haloperidol — is associated with cost savings and is the dominant strategy in terms of cost effectiveness.

The efficacy and tolerability profile of long-acting injectable risperidone, its ability to reduce hospitalization rates and improve HR-QOL, and its demonstrated cost effectiveness in pharmacoeconomic models support the use of this agent in the management of schizophrenia.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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    Monique P. Curran & Gillian M. Keating

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Correspondence to Monique P. Curran.

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Various sections of the manuscript reviewed by: A.C. Altamura, Department of Psychiatry, University of Milan, Milan, Italy; N.H. Bhanji, Peter Lougheed Hospital, Calgary, Alberta, Canada; P.S. Chue, Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; B. Dell’Osso, Department of Psychiatry, University of Milan, Milan, Italy; J.M. Kane, The Zucker Hillside Hospital, Glen Oaks, New York, USA; R.C. Love, University of Maryland, Baltimore, Maryland, USA; A.M. Mortimer, University of Hull, Hull, England; G.L. Stimmel, USC Schools of Pharmacy and Medicine, Los Angeles, California, USA.

Data Selection

Sources: Medical literature published in any language since 1980 on ‘risperidone’, identified using MEDLINE, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: MEDLINE search terms were ‘risperidone’ and (‘intramuscular’ or ‘depot’ or ‘injectable’ or ‘injection’ or ‘long-acting’) and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programs’ or ‘epidemiology’ or ‘outcome-assessment-health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘polic* in ti’ or ‘expert panel’ or ‘utilization review’ or ‘algorithms’ or ‘disease management’ or ‘quality of life’) or ‘schizophrenia’ and ‘review in pt’. AdisBase search terms were ‘risperidone’ and (‘intramuscular’ or ‘depot’ or ‘injectable’ or ‘injection’ or ‘long-acting’) and (‘guideline' or ‘guideline-utilization' or ‘practice-guideline’ or ‘disease-management-programs' or ‘treatment-algorithms’ or ‘reviews-on-treatment' or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’) or ‘schizophrenia’ and (‘review’ or ‘clinical-study’). Searches were last updated on March 16, 2006.

Selection: Studies in patients with schizophrenia who received long-acting injectable risperidone. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, pharmacoeconomic, and epidemiologic data are also included.

Index terms: Long-acting injectable risperidone, schizophrenia, therapeutic use, tolerability, disease management, review on treatment.

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Curran, M.P., Keating, G.M. Management of Schizophrenia. Dis-Manage-Health-Outcomes 14, 107–125 (2006). https://doi.org/10.2165/00115677-200614020-00006

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