Earlier Use of Long-Acting Injectable Treatments for Schizophrenia Has Multiple Benefits

In an interview with Pharmacy Times, Michael McGuire, PharmD, a professor of pharmacy practice at the Belmont University College of Pharmacy and Health Sciences, discussed the use of long-acting injectable (LAI) medications earlier in the treatment of schizophrenia, rather than holding them as a last resort. Research has demonstrated a reduction in hospitalization risk associated with the use of LAIs, but some barriers can prevent the wider adoption of this approach.

Pharmacy Times: What are the primary barriers preventing wider adoption of LAIs earlier in the treatment process, rather than reserving them for treatment failure or nonadherence?

Michael McGuire, PharmD: So, a lot of patients are afraid of needles. That's probably the most common objection that we’ll get, is that they're afraid of a needle stick, which I get. Sometimes we've got paranoia that's present there about us injecting medicine, and they don't know what it is. That's usually not the big objection that I get. It's more a fear of needles. Sometimes there's just an uncertainty diagnostically. If we're seeing somebody for the first time with a first episode of psychosis, is this schizophrenia, and is this person going to need long-term antipsychotic therapy? So, in those kinds of cases, we don't necessarily jump to an LAI because we don't [know if] that person is looking at lifelong antipsychotic therapy, or is this short term?

And one of the barriers that we [often] get is where patients can go to get the LAI administered. Do they have easy access to a clinic or to a pharmacy or some site where they can get it administered? As well as insurance coverage. Insurance coverage is less of a barrier than it used to be, but we still have some plans that don't cover LAIs at all. In my acute setting, we always check insurance coverage before we administer any of them, so we know a patient doesn't go to the pharmacy and try to pick it up and then it's not covered. So, we try to take care of the prior authorization process in the hospital, but not every facility does that. Not everybody has the ability to do that, so there are some steps that we have to go through to get there for a lot of patients.

Pharmacy Times: How could earlier use of LAIs impact patient outcomes, and what are the key arguments in favor of this approach?

McGuire: Well, I think the hope is, obviously, if we can get patients stabilized on medication sooner, rather than a last resort, we can decrease rehospitalization rates, saving money, saving the patient's mental health. The more rehospitalizations they have, the more episodes of being on and off of medicines that they have, the more that their disease deteriorates, and the harder time we have getting them stable. So, if we can get them stable on medications, hopefully that's going to, in turn, result in decreased rehospitalization rates, improved overall functioning, improving functioning with family and loved ones, stable housing, less utilization of resources. This is such an expensive illness [and] nonadherence drives so much of the cost of the illness. But it's not just nonadherence. There is a benefit, I think, to steadier blood levels for patients, and they seem to tolerate that better. And we also know that the medicine is in there, versus did they actually take their medicine today? Family having to hassle the patient every day, ‘Did you take your medicine? Did you take it? Did you not?’ If there's an injection, we know that it's been administered, and we can follow that a little bit a little bit closer, so there are a ton of benefits to using these earlier on in treatment, rather than last.