Patients with a recent first episode of schizophrenia who are treated with a long-acting injectable (LAI) formulation of the antipsychotic risperidone may experience lower rates of psychotic relapse and better control of psychotic symptoms than those treated with oral risperidone, according to a study published this week in JAMA Psychiatry.
For the study, Kenneth Subotnik, Ph.D., a research psychologist at the University of California, Los Angeles, and colleagues randomized 83 patients with recent-onset schizophrenia to receive LAI risperidone (25 mg every two weeks) or oral risperidone (2 mg daily) over a 12-month period. Furthermore, half of the patients in each group were simultaneously randomized to receive cognitive remediation (a cognitive training program of at least one hour a week) or healthy-behaviors training (weekly instruction in relaxation, healthy eating habits, and exercise).
The results showed that psychotic exacerbation and/or relapse rate was lower for the LAI risperidone group compared with the oral group (5% versus 33%), and LAI risperidone was significantly associated with lower levels of hallucinations and delusions throughout the follow-up period. The proportion of patients who required psychiatric hospitalization was significantly lower for LAI risperidone than for oral risperidone (5.0% versus 18.6%), and treatment with the LAI risperidone led to significantly better medication adherence.
The cognitive remediation and healthy-behaviors training groups did not differ significantly regarding psychotic relapse, psychotic symptom control, or hospitalization rates. There were no significant interactions between the two medications and the two psychosocial treatments.
“The superiority of long-acting injectable risperidone extends beyond preventing psychotic symptom return,” the researchers noted. “Use of long-acting injectable risperidone in our first-episode patients also led to better maintenance of intracortical myelination as well as improved cognitive functioning,” they wrote. “If this trifecta of improved psychotic symptom control, cognition, and intracortical myelination can be replicated in longer longitudinal studies of patients with a first episode of schizophrenia, it would suggest that the use of long-acting injectable antipsychotics early in schizophrenia can modify the trajectory of the disorder and lead to better long-term outcomes.”