23 May Schizophrenia Treatment Maintenance: Comparison of Long Acting Injectable Medications
MedicalResearch.com Interview with:
Scott Stroup, MD, MPH
Professor of Psychiatry
Director, Program for Intervention Effectiveness Research,
Associate Director for Adult Services, Division of Mental Health Services and Policy Research, New York State Psychiatric Institute
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
MedicalResearch: What are the main findings of the study?
Dr. Stroup: We conducted a study sponsored by the National Institute of Mental Health that compared long-acting injectable antipsychotics for people with schizophrenia. Long-acting injectable antipsychotics, also known as depot antipsychotics, are used to promote treatment adherence. We compared a newer injectable antipsychotic, paliperidone palmitate, to an older one, haloperidol decanoate. We did not find an advantage for the newer drug in overall effectiveness. The drugs performed very similarly, and were tolerated about the same.
MedicalResearch: Were any of the findings unexpected?
Dr. Stroup: We hypothesized that the newer drug would be better. Many people might have expected the newer, more expensive, drug to have significant advantages, particularly in tolerability. The doses of haloperidol decanoate used in the study—about 75 mg per month on average—were lower than are typically used and this may have improved its tolerability. Nevertheless, haloperidol caused more restlessness than paliperidone. But paliperidone caused weight gain and increases in prolactin levels, while haloperidol did not.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Stroup: Long-acting injectable medications are an important option for people who have been diagnosed with schizophrenia and are at risk of relapse due to treatment non-adherence. For people who want to use a long-acting injectable medication, haloperidol decanoate is a relatively inexpensive choice that works well. If you use haloperidol decanoate, modest doses may be optimal for most patients. However, anyone taking an antipsychotic should be carefully monitored for side effects.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Stroup: It’s important to continue the search for new drugs and other treatments for schizophrenia that are better than those now available. In the meantime we need to know how best to use currently available treatments, including psychosocial treatments, to improve opportunities for recovery. We also need to know the best ways to help people with schizophrenia lose weight, stop smoking, and engage in more physical activity to help avoid medical problems and reduce premature mortality.
McEvoy JP, Byerly M, Hamer RM, et al. Effectiveness of Paliperidone Palmitate vs Haloperidol Decanoate for Maintenance Treatment of Schizophrenia: A Randomized Clinical Trial. JAMA. 2014;311(19):1978-1987. doi:10.1001/jama.2014.4310.