Safety Profile Sways Physicians on Use of LAIs for Schizophrenia

NASHVILLE, Tenn. -- Psychiatric care providers most often ranked the side effect profile of long-acting injectables (LAIs) for schizophrenia as the top consideration when prescribing the antipsychotics to patients, a survey-based study found.

Among 380 respondents, 33% cited the safety/tolerability profile as key when selecting an LAI, with 16% to 21% of the respondents citing patient preference, the particular molecule in the LAI, access, or product attributes like dosing intervals or injection site as most important, reported Dawn Velligan, PhD, of the University of Texas Health Science Center in San Antonio, during a poster session at Psych Congress 2023.

LAIs are underused, despite data showing they can improve outcomes for patients with schizophrenia, according to the study.

"Why are some healthcare professionals willing to -- and able to -- utilize LAI and get through the barriers of LAI use and others don't seem to be able to do so?" said Velligan.

Overall, 32% of the respondents surveyed tended to use LAIs as early as possible, 30% reserved their use for patients with adherence issues, 23% saved them for patients with more severe symptoms, and 15% of providers were considered hesitant to prescribe due to various concerns, including access to treatment.

Among the so-called hesitant group, the LAI's side effect profile ranked as the top concern (46% of respondents) followed by access (27%).

The researchers also broke down the respondents by high-LAI use (n=106) and low-LAI use (n=130). Clinicians who reported higher use of LAIs tended to see more schizophrenia patients on a monthly basis (88 vs 27 for the low-use group). High users' most important consideration was the product's attributes (26%), such as dosing intervals or the site of injection, and its side effect profile (26%). Only 13% of clinicians who reported lower use of LAI said that product attributes were most important.

"Positive attitudes toward LAI are correlated with knowledge about LAI," Velligan said, adding that frequent prescribers tended to use LAIs for their patients with adherence problems and those with multiple relapses.

She said that understanding the nature of these attitudes and how they differ among psychiatric care providers was the reason they conducted the survey.

High LAI prescribers were more confident in resolving patient issues, deciding on an LAI or switching therapies when needed, and in selling patients on the potential benefits of the drugs, Velligan said. "They know how to make the offer that people are going to accept. They feel good talking about the pros and cons."

She also said that these clinicians feel more confident in their knowledge of LAIs and more competent in dealing with any potential side effects that could arise.

"What that tells us is that when people get the education, when people get the training, they're much more likely to use LAI," Velligan said.

The DECIDE survey was distributed from March to July 2022 using direct emails for U.S.-based physicians (n=295), along with nurse practitioners and physician assistants (n=85) who indicated their specialty was psychiatry. Eligible clinicians had to manage at least one patient with schizophrenia per month.

Most respondents worked in community settings (82%). On overage they had 20 years of psychiatric experience, saw a mean 58 patients with schizophrenia each month, and 25% of their patients with schizophrenia were on LAIs. High LAI users included clinicians who had 31% or more of their schizophrenia patients taking antipsychotic agents on LAIs, whereas low LAI users had 14% or fewer of these patients on LAIs.

When researchers asked about the least important concern among the clinicians, the largest share of respondents cited the drug's molecule (47%), followed by access (19%), patient preference (17%), product attributes (11%), and the side effect profile (3%).

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