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Evidence-Based Expert Consensus Regarding Long-Acting Injectable Antipsychotics for Schizophrenia from the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN)

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Abstract

Objective

Schizophrenia is a chronic, debilitating psychiatric disorder with a high risk of relapse. Nonadherence to medication is a significant contributor to poor outcomes. Although long-acting injectable (LAI) antipsychotics prevent the relapse of schizophrenia, several factors present obstacles to the use of LAI antipsychotics, and clinical guidelines for LAI antipsychotics remain limited. To provide clinical recommendations, the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) developed consensus statements for the effectiveness, target populations, initiation timing, and particular clinical situations for the use of LAI antipsychotics in patients with schizophrenia.

Methods

After a systematic literature review, a working group drafted consensus statements for the selected clinical topics and determined the levels of evidence-based recommendation based on the latest World Federation of Societies of Biological Psychiatry grading system. A scientific committee evaluated the draft statements and decided the final recommendations regarding the grades by anonymous voting after incorporating clinical experience and practice into the evidence from research.

Results

The TSBPN proposed ten consensus statements for the application of LAI antipsychotics. The current evidence supported that LAI antipsychotics could be a treatment option for all schizophrenia patients, including first-episode patients. LAI antipsychotics could be initiated both during an acute psychotic episode and when patients are stable. The consensus also gave recommendations for particular clinical situations with insufficient scientific data, such as for use in elderly or adolescent patients, patients with treatment-resistant schizophrenia, and breakthrough psychosis, and strategies to assist patients/caregivers with decision making.

Conclusions

The consensus statements developed by the TSBPN provide evidence-based clinical recommendations and could give clinicians more confidence when prescribing LAI antipsychotics to treat schizophrenia, thereby improving treatment outcomes.

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Acknowledgements

The authors thank the experts of the scientific committee for their contributions to the formulation of the statements and the determination of the recommendation levels. The members of the committee are (listed according to the order of the last name) Dr Cheng-Sheng Chen (Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan), Dr Po-See Chen (Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan), Dr Shao-Tsu Chen (Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan), Dr Yi-Ling Chien (Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan), Dr Nan-Ying Chiu (Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan), Dr Chun-Kai Fang (Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan), Dr Ming-Hsien Hsieh (Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan), Dr Yu-Shu Huang (Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan), Dr Chau-Shoun Lee (Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan), Dr Chun-Hung Lee (Department of Forensic and Addiction Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan), Dr Ching-Hua Lin (Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan), Dr Chia-Yih Liu (Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan), Dr Lih-Jong Shen (Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei, Taiwan) and Dr Yung-Chieh Yen (Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan).

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Author notes

  1. Kai-Chun Yang and Yin-To Liao contributed equally to the work.

Authors and Affiliations

  1. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Rd., Beitou, 11217, Taipei, Taiwan

    Kai-Chun Yang & Ya-Mei Bai

  2. Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Kai-Chun Yang & Ya-Mei Bai

  3. Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan

    Yin-To Liao

  4. Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Yin-To Liao

  5. Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Yen-Kuang Yang

  6. Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Yen-Kuang Yang

  7. Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan

    Yen-Kuang Yang

  8. Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan

    Shih-Ku Lin

  9. Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan

    Shih-Ku Lin

  10. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Shih-Ku Lin

  11. Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, No.60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan

    Chih-Sung Liang

  12. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan

    Chih-Sung Liang

  13. Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Ya-Mei Bai

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  1. Kai-Chun Yang
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  2. Yin-To Liao
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  3. Yen-Kuang Yang
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  4. Shih-Ku Lin
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  5. Chih-Sung Liang
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  6. Ya-Mei Bai
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Correspondence to Chih-Sung Liang or Ya-Mei Bai.

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Conception and design of the study: Y.-M.B., Y.-K.Y., and S.-K.L.; literature review: K.-C.Y., Y.-T.L., C.-S.L., and Y.-M.B.; formulation of drafted statements: all authors; drafting the manuscript and tables: K.-C.Y., Y.-T.L., C.-S.L., and Y.-M.B. All authors have reviewed and approved the final manuscript. All authors agree to be accountable for the information provided in the manuscript.

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Yang, KC., Liao, YT., Yang, YK. et al. Evidence-Based Expert Consensus Regarding Long-Acting Injectable Antipsychotics for Schizophrenia from the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN). CNS Drugs 35, 893–905 (2021). https://doi.org/10.1007/s40263-021-00838-5

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