The Role of Long-Acting Injectable Antipsychotics in the Early Treatment of Schizophrenia

Early and effective treatment of schizophrenia, within approximately the first 5 years after diagnosis, can help maximize responses and minimize functional decline and worsening of clinical outcomes. Suboptimal treatment selection in this early phase may increase the risk of relapse and negatively impact treatment adherence. Compared with daily oral antipsychotics (OAPs), long-acting injectable (LAI) antipsychotics, with dosing intervals of every 2 weeks or longer, provide consistent steady-state levels of medication and are useful for improving antipsychotic treatment adherence. Initiating LAI treatment as early as the first episode and within the first 5 years of illness has been associated with better treatment outcomes. Despite their well-known benefits, many clinicians reserve the initiation of LAIs for patients who have experienced relapse, often due to demonstrated non-adherence to OAPs, instead of using LAIs earlier after a schizophrenia diagnosis and before multiple relapses occur. This review highlights the advantages of initiating an LAI treatment earlier after a schizophrenia diagnosis, including LAI potential to reduce relapse rates, improve overall functioning, and reduce healthcare resource utilization and associated costs. The perceived barriers to early adoption of LAIs, strategies to reduce these barriers, and increase physician and patient confidence in LAIs are discussed. Additionally, we examine the current treatment guidelines for recommendations on early use of LAIs. Taken together, early use of LAIs is associated with improved patient outcomes, reduced relapse risk, and lower overall healthcare costs. Encouraging the adoption of LAIs as first-line treatment in clinical practice could help optimize long-term outcomes for patients with early phase schizophrenia. This review also highlights the evidence gaps and practical implications for clinical decision making.