In a comparative study published in JAMA Network Open, paliperidone 3-month long-acting injectable was associated with the lowest risk of relapse and treatment failure among patients with schizophrenia spectrum disorders compared to oral olanzapine and other antipsychotics. The extended administration interval of paliperidone 3-month long-acting injectable contributed to its effectiveness in preventing these outcomes.
Researchers conducted a within-individual analysis using Swedish healthcare register data from 131,476 participants to evaluate antipsychotic effectiveness in preventing relapse and treatment failure. The study population had a mean age of 45.7 years (standard deviation, 16.2 years), with 53.3% male participants. The median follow-up period was 12 years (interquartile range, 5.2 to 16 years).
During follow-up, 48.5% of participants (63,730 individuals) experienced at least one psychotic relapse, and 71.1% (93,464 individuals) encountered treatment failure, defined as psychiatric hospitalization, death, or a change in antipsychotic medication.
Among the antipsychotics, paliperidone 3-month long-acting injectable (LAI) had the lowest adjusted hazard ratio (AHR) for relapse at 0.66 (95% confidence interval [CI], 0.51-0.86), followed by aripiprazole LAI (AHR, 0.77; 95% CI, 0.70-0.84), olanzapine LAI (AHR, 0.79; 95% CI, 0.73-0.86), and clozapine (AHR, 0.82; 95% CI, 0.79-0.86). Quetiapine had the highest risk of relapse with an AHR of 1.44 (95% CI, 1.38-1.51). A post-hoc sensitivity analysis confirmed this, even when small-dose quetiapine was excluded.
For treatment failure, paliperidone 3-month LAI also showed the lowest AHR at 0.36 (95% CI, 0.31-0.42). Aripiprazole LAI (AHR, 0.60; 95% CI, 0.57-0.63), olanzapine LAI (AHR, 0.67; 95% CI, 0.63-0.72), and paliperidone 1-month LAI (AHR, 0.71; 95% CI, 0.68-0.74) also demonstrated a reduced risk of treatment failure compared to oral olanzapine.
This large-scale, real-world study highlighted significant differences in the effectiveness of antipsychotics, with paliperidone 3-month LAI standing out due to its long administration interval, making it a key consideration for relapse prevention in schizophrenia.
Full disclosures can be found in the published study.