Scholarlink

Background <p>Individuals with schizophrenia and comorbid substance use disorder (SUD) often experience poor treatment adherence, leading to worse clinical outcomes. However, high-quality evidence from randomized trials on the preferred mode of antipsychotic treatment in this population remains limited.</p> Aims <p>The aim was to examine whether long-acting injectable (LAI) antipsychotic treatment reduces the risk of all-cause discontinuation (ACD) compared with oral antipsychotics in individuals with early phase schizophrenia and comorbid SUD.</p> Methods <p>This study was a secondary analysis of the European Long-Acting Antipsychotics in Schizophrenia Trial (EULAST), a multisite, randomized, open-label trial conducted across multiple European healthcare settings. A total of 471 individuals with early phase schizophrenia were included in this secondary analysis, stratified by presence (<i>n</i> = 143) or absence (<i>n</i> = 328) of comorbid SUD. The observation period lasted 18 months. Participants were randomly assigned to second-generation LAI or oral second-generation antipsychotic treatment. The primary outcome was ACD, an indirect measure of treatment efficacy, defined as discontinuation of the initially assigned treatment for any reason. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models, adjusted for relevant covariates.</p> Results <p>Among 143 individuals with schizophrenia and SUD, LAI treatment was associated with a 36% lower risk of ACD compared with oral antipsychotics (adjusted HR = 0.641; 95% CI, 0.438–0.938; <i>P</i> = 0.022). Kaplan–Meier curves showed longer median time to ACD for LAI treatment (158 days) versus oral antipsychotics (97 days). By contrast, among the 328 individuals without SUD, LAI treatment did not significantly reduce ACD risk (<i>P</i> = 0.282). Crude HRs were also assessed, replicating the adjusted hazard findings.</p> Conclusions <p>LAI antipsychotics significantly delayed treatment discontinuation compared with oral antipsychotics in participants with early phase schizophrenia and comorbid SUD but not in those without SUD. While these findings provide robust evidence supporting the use of LAIs in people with schizophrenia and comorbid SUD, future studies are needed to more precisely quantify the potential clinical benefits and tolerability of LAIs in this high-risk population. EULAST was registered at ClinicalTrials.gov (NCT02146547).</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Impact of Long-Acting Injectable Versus Oral Antipsychotic Treatment on All-Cause Discontinuation Risk in People with Early Phase Schizophrenia and Comorbid Substance Use Disorder: A Secondary Analysis of the EULAST Randomized Trial

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月11日

查看全文
  • Matin Mortazavi,
  • Zahra Aminifarsani,
  • Inge Winter-van Rossum,
  • René S. Kahn,
  • W. Wolfgang Fleischhacker,
  • Michael Davidson,
  • Mark Weiser,
  • Dan Siskind,
  • Stefan Leucht,
  • René Sylvain Kahn,
  • Walter Wolfgang Fleischhacker,
  • Jurjen Luykx,
  • Monica Mosescu,
  • Silvana Galderisi,
  • Marina Kupchik,
  • Nikos Stefanis,
  • Alexander Teitelbaum,
  • Paola Rocca,
  • Georg Psota,
  • George Umoh,
  • Istvan Bitter,
  • Lucho Hranov,
  • Alex Hofer,
  • Joachim Cordes,
  • Ramin Nilforooshan,
  • Julio Bobes,
  • Solveig Klebo Reitan,
  • Manuel Morrens,
  • Aurel Nirestean,
  • John Geddes,
  • Benedicto Crespo Faccorro,
  • Marcin Olajossy,
  • Alessandro Rossi,
  • Erik Johnsen,
  • Csekey László,
  • Adela Ciobanu,
  • Peter Haddad,
  • Igor Oife,
  • Miquel Bernardo,
  • Rodicutza Stan,
  • Marek Jarema,
  • Dan Rujescu,
  • Libor Ustohal,
  • Neil Mayfield,
  • Paola Dazzan,
  • Avi Valeversuski,
  • Jan Libiger,
  • Richard Köhler,
  • Pavel Mohr,
  • Sofia Pappa,
  • Petros Drosos,
  • Thomas Barnes,
  • Esther DeClercq,
  • Paola Bucci,
  • Armida Mucci,
  • Yaacov Rabinowitz,
  • Adam Adamopoulous,
  • Benjamin Draiman,
  • Cristiana Montemagni,
  • Manfred Greslechner,
  • Hannah Herlihy,
  • Csilla Bolyos,
  • Christian Kraepelin-Schmidt,
  • Jessica True,
  • Leticia Alvarez Garcia,
  • Berit Walla,
  • Bernhard Sabbe,
  • Lucaks Emese,
  • Sarah Mather,
  • Nikodem Skoczen,
  • Serena Parnanzone,
  • Jill Bjarke,
  • Krisztina Karácsonyi,
  • Steve Lankshear,
  • Marina Garriga,
  • Adam Wichniak,
  • Heidi Baumbach,
  • Timo Schurr,
  • Leonie Willebrands,
  • Lyliana Nasib,
  • Cynthia Okhuijsen-Pfeifer,
  • Elianne Huijsman,
  • Alkomiet Hasan,
  • Elias Wagner

摘要

Background

Individuals with schizophrenia and comorbid substance use disorder (SUD) often experience poor treatment adherence, leading to worse clinical outcomes. However, high-quality evidence from randomized trials on the preferred mode of antipsychotic treatment in this population remains limited.

Aims

The aim was to examine whether long-acting injectable (LAI) antipsychotic treatment reduces the risk of all-cause discontinuation (ACD) compared with oral antipsychotics in individuals with early phase schizophrenia and comorbid SUD.

Methods

This study was a secondary analysis of the European Long-Acting Antipsychotics in Schizophrenia Trial (EULAST), a multisite, randomized, open-label trial conducted across multiple European healthcare settings. A total of 471 individuals with early phase schizophrenia were included in this secondary analysis, stratified by presence (n = 143) or absence (n = 328) of comorbid SUD. The observation period lasted 18 months. Participants were randomly assigned to second-generation LAI or oral second-generation antipsychotic treatment. The primary outcome was ACD, an indirect measure of treatment efficacy, defined as discontinuation of the initially assigned treatment for any reason. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models, adjusted for relevant covariates.

Results

Among 143 individuals with schizophrenia and SUD, LAI treatment was associated with a 36% lower risk of ACD compared with oral antipsychotics (adjusted HR = 0.641; 95% CI, 0.438–0.938; P = 0.022). Kaplan–Meier curves showed longer median time to ACD for LAI treatment (158 days) versus oral antipsychotics (97 days). By contrast, among the 328 individuals without SUD, LAI treatment did not significantly reduce ACD risk (P = 0.282). Crude HRs were also assessed, replicating the adjusted hazard findings.

Conclusions

LAI antipsychotics significantly delayed treatment discontinuation compared with oral antipsychotics in participants with early phase schizophrenia and comorbid SUD but not in those without SUD. While these findings provide robust evidence supporting the use of LAIs in people with schizophrenia and comorbid SUD, future studies are needed to more precisely quantify the potential clinical benefits and tolerability of LAIs in this high-risk population. EULAST was registered at ClinicalTrials.gov (NCT02146547).