By Gina Shaw
To alleviate knowledge gaps and clarify the role of long-acting injectable (LAI) antipsychotic agents in treating patients with schizophrenia, a panel of experts has developed Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement (S.C.O.P.E.), a new digital educational platform for healthcare professionals.
At the 2023 Psych Congress, Christoph Correll, MD, a professor of psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, in Hempstead, N.Y., and psychiatrist at Zucker Hillside Hospital, in Glen Oaks, N.Y., introduced S.C.O.P.E. and its capabilities.
“We know that antipsychotics reduce the relapse risk in schizophrenia compared with placebo with a number needed to treat [NNT] of three, which compares very well to common drugs for other medical conditions,” Dr. Correll said (JAMA Psychiatry 2020;77[12]:1-8; Br J Psychiatry 2012;200[2]:97-106).
“With drugs such as statins or ACE [angiotensin-converting enzyme] inhibitors for cardiovascular disease, there is a NNT of 30 to 60 to prevent one relapse (BMC Med 2015;13:253),” he added. “Unfortunately, patients with schizophrenia often stop oral medications, especially early on in the course of illness—and these are the patients with the most to gain and the most to lose.
Dr. Correll cited another challenge: “We don’t know ahead of time which patients will be nonadherent. But we do know, from a meta-analysis of randomized controlled trials, cohort studies and mirror image studies that included 13,737 studies with almost 400,000 people, that LAIs can prevent relapses and hospitalizations much better than standard oral treatments” (Lancet Psychiatry 2021;8[5]:387-404).
LAIs remain under-prescribed, however, for multiple reasons. “The first issue is time,” Dr. Correll said. “Clinicians are busy and often have only about 10 to 15 minutes per checkup. Prescribers know that they will need more time to explain the use of the LAIs to patients, and it’s easier just to write a prescription for an oral antipsychotic. But that’s penny-wise and pound-foolish.”
Many clinicians “lack knowledge about practical issues in the use of LAIs,” he added. “This includes dose selection, pharmacokinetics and what to do when a patient is late for an injection or has persistent symptoms after starting therapy.”
Dr. Correll also noted that prescribers may inaccurately believe that patients will take their oral medications as prescribed and that they will reject LAIs. “People may project their own lack of interest in needles or experiencing pain or being away from the ‘medical model,’ and say that patients will not like it,” he said. “But the data suggest that a significant number of patients have never even been offered LAIs. When patients receive motivational interviewing to identify their goals and link them to continued antipsychotic treatment that is best and most reliably achieved with LAIs, they are much more likely to choose them” (CNS Drugs 2021;35[11]:1189-1205).
The S.C.O.P.E. platform “gives clinicians the structure and education they need around LAIs and helps coach them in evaluating patients, including how to identify risk factors for relapse,” he added. “With case-based learning drawn from the literature that supports each step, we hope that this free tool will help clinicians broaden their toolbox and feel more comfortable with selecting LAIs so that patients can get the care that they need.”
Dr. Correll also noted that in an increasing number of states, pharmacists have the authority to administer LAIs, which could improve access to these agents. “Pharmacies can provide these injections in a decentralized way; for many patients, they’re right around the corner,” he said. “This also allows patients not to have to return to the hospital for injections, which may make them feel stigmatized.”
Dr. Correll reported that he has served as a consultant to and/or advisor for, or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, CSL Seqirus, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, Intra-Cellular Therapies, Jamjoom Pharma, Janssen/Johnson & Johnson, Karuna, LB Pharmaceuticals, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurelis, Neurocrine, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex and Viatris.
