LAUSR

The reduction of adverse outcomes is of crucial importance in schizophrenia, a relapsing and remitting chronic illness with a 13- to 15-year reduction in life expectancy. 1 The recurrence of acute psychotic symptoms after a period of recovery is often highly distressing to individuals with schizophrenia and is associated with a reduced response to antipsychotic treatment. 2 The prevention of relapses of acute psychosis and psychiatric hospitalizations early in the course of illness has major prognostic implications in schizophrenia and related psychotic disorders. In a case series study of 70396 individuals with schizophrenia, Wei et al 3 found a lower risk of suicide attempts, all-cause hospitalizations, and psychiatric hospitalizations associated with long-acting injectable antipsychotic (LAIA) treatment compared with oral antipsychotic (OA) treatment. Furthermore, Wei et al 3 also demonstrated a lower risk of extrapyramidal symptoms and fewer hospitalizations for cardiovascular diseases and for somatic disorders during LAIA treatment compared with OA treatment. There was an increase in the risk of extrapyramidal symptoms among elderly individuals within the first 90 days of LAIA treatment. By using a self-controlled case series design in which individuals act as their own control, the authors mitigated the effect of fixed confounders that do not change over time. Furthermore, with a mean (SD) duration of follow-up of 12.5 (4.7) years, this case series study informs our understanding of the long-term tolerability and effectiveness of LAIA treatment in improving longitudinal outcomes among people with schizophrenia. The study adds to an existing work supporting both the safety of LAIAs and the superior effectiveness of LAIA treatment compared with OA treatment in reducing hospitalizations for acute psychosis among individuals with schizophrenia. A 2021 systematic review and comparative meta-analysis Kishimoto found no significant differences in the risk of extrapyramidal symptoms and most adverse events between LAIA and OA treatment. review demonstrated an Further research on the effectiveness and tolerability of individual LAIA formulations in early psychosis is essential to guide shared decision-making between clinicians and patients during the critical early years of psychotic illness.