Elicit: Aripiprazole LAI Outcomes in Schizophrenia (public)
In adults with schizophrenia stabilized on oral aripiprazole, what are relapse and hospitalization outcomes, adherence, and metabolic AEs with monthly aripiprazole LAI vs other LAIs in real-world Spanish settings?
Real-world Spanish data showed monthly aripiprazole LAI had significantly higher hospitalization rates than 3-monthly paliperidone (21.2% vs 8.3%), with similar relapse rates between LAI types and limited data on adherence and metabolic adverse events.
Abstract
Adults with schizophrenia treated in Spanish clinical settings show that long‐acting injectable (LAI) antipsychotics are associated with reduced hospital admissions relative to pre‐LAI periods. In studies comparing formulations, paliperidone palmitate administered every 3 months yielded lower hospitalization rates than aripiprazole once monthly—for example, one study reported admissions of 8.3% with paliperidone versus 21.2% with aripiprazole (hazard ratio 2.22, p < 0.01). Relapse outcomes were sparsely reported; one investigation noted approximately a 20% relapse rate (80% abstinence) with no significant differences between LAI types.
Adherence measures indicate high treatment retention with LAIs. One study of first‐episode psychosis patients reported 90.4% retention at one year for aripiprazole compared with 58.7% to 53.3% for paliperidone, while other investigations showed retention rates exceeding 90% in various cohorts. Data on metabolic adverse events were limited; one study documented a 3.1% rate of metabolic disturbances without additional findings on weight change. Overall, the available evidence suggests that, in real‐world Spanish practice, monthly aripiprazole LAI may be associated with higher hospitalization rates than some paliperidone formulations, whereas differences in relapse rates, treatment adherence, and metabolic safety remain less consistently defined.
Methods
We analyzed 15 sources from an initial pool of 997, using 8 screening criteria. Each paper was reviewed for 6 key aspects that mattered most to the research question.
Characteristics of Included Studies
| Study | Study Design | Population | Long-Acting Injectable (LAI) Comparisons | Follow-up Duration |
|---|---|---|---|---|
| Sapin et al., 2015 | Randomized controlled trial, open-label | Stabilized adults with schizophrenia | Aripiprazole once monthly 400 mg vs. paliperidone palmitate 50-150 mg | 28 weeks |
| García‐Carmona, 2018 | Retrospective cohort | Schizophrenia, LAI users | Paliperidone long-acting injectable vs. aripiprazole, zuclopentixol, risperidone long-acting injectables | 3 years |
| Rojas et al., 2021 | Retrospective cohort | Schizophrenia, n=2275 | Paliperidone palmitate 1-monthly, paliperidone palmitate 3-monthly, aripiprazole once monthly, oral antipsychotics | 12 months |
| Lopez et al., 2021 | Mirror image, retrospective cohort | First episode psychosis, n=277 | Paliperidone long-acting injectable 3-monthly vs. aripiprazole long-acting injectable 1-monthly | Not specified |
| García‐Carmona et al., 2022 | Cross-sectional | LAI users, n=993 | Paliperidone palmitate 1-monthly, paliperidone palmitate 3-monthly, aripiprazole once monthly, risperidone long-acting injectable | 1 year |
| Vidal-Millares et al., 2024 | Prospective observational | Dual diagnosis, n=280 | Aripiprazole long-acting injectable vs. paliperidone long-acting injectable | 5 years |
Relapse and Hospitalization Outcomes
Summary of findings:
- Hospitalization rate: Quantitative data reported significant reductions in hospitalizations with LAIs.
- Relapse rate: Reported rates were often sparse, with one study reporting approximately a 20% relapse rate.
Treatment Adherence and Persistence
Summary of findings:
- Treatment retention: High retention rates often reported, above 90% for some LAIs.
- Adherence: Variable reporting, with some studies indicating improved adherence compared to oral antipsychotics.
Metabolic Adverse Events
Summary of findings:
- Sparse data on metabolic side effects, with only one study noting a 3.1% rate of metabolic disturbances.
Comparative Effectiveness in Spanish Healthcare Settings
The initiation of long-acting injectables, including the aripiprazole LAI, generally leads to reduced hospitalizations and improved adherence in clinical practice. However, differences in effectiveness remain inconsistent across studies, with limited data on relapse rates and metabolic events.
References
- N. García et al. (2017) - Long acting injectable aripiprazole: An observational study.
- L. Rojas et al. (2021) - Assessment of hospitalizations in schizophrenia patients.