Professional Documents
Culture Documents
Goenawan
40%
20%
0%
-1990
91-93
94-96
97-99
00-02
03-05
06-08
Jacobsson, 1980
prefer oral
prefer depot
Eastwood, 1997
prefer combination
no preference
Pereira, 1997
missing data
Hoencamp, 1995
0
50
100
patients (%)
Walburn J et al: Br J Psychiatry 2001;179:3007
Depot/LAI experienced
patients (n=155)
never been treated with a
depot/LAI formulation before
(depot/LAI naive)
(n=145)
current
Depot/LAI
treatment
(n=60)
previous
Depot/LAI
treatment
(n=95)
Myths vs Facts #1
Punishment, an intrusive
treatment
Reserved for more serious illness
Problematic Patients
Last Resort
Stigmatizing, coercive, challenge
to patient autonomy 1,2
1.
2.
3.
4.
5.
6.
7.
8.
Myths vs Facts #2
1.
2.
3.
4.
percent
FGA
SGA
p < 0.001
N=246
sufficient
depot
no depot in first
compliance with recommended but episode patients
oral drug
patient refused
percent
FGA
SGA
p < 0.001
N=246
costs of drug
Who is considered
to be a candidate
for depot/LAI treatment ?
Who is considered to be
a candidate for depot/LAI treatment?
Relapses and non-compliance in the past were
considered most strongly designating patients for
antipsychotic depot treatment apart from
archaic/conservative depot/LAI domains like suicidal
risk or hazard risk for others [cluster A]
Cost effectiveness:
RLAI vs alternative antipsychotic agents in patients with
schizophrenia (> 1 year - USA)
HLP Depot
RLAI
60%
41%
24%
28
18
11
Relapse requiring
rehospitalization
pre-LAI treatment
18 months
LAI treatment
18 months
9 mo
(N=59)
12 mo
(N=50)
15 mo
(N=40)
18 mo
(N=36)
Pre RLAI
51.4
53.7
61.9
70.3
74.5
During RLAI
25.3
24.9
34.5
31.8
36.1
9 mo
(N=59)
12 mo
(N=50)
15 mo
(N=40)
18 mo
(N=36)
Pre RLAI
1.6
6.5
11.2
12.3
18.1
During RLAI
2.6
3.6
5.2
6.9
7.7
100
90
80
70
60
50
40
30
20
10
0
21.7
4.3
at least one
hospitalization
>1 hospitalizations
Relapse Risk
Under depot/LAI versus oral antipsychotic treatment
(data from RCTs and meta-analysis)
Relapse Rates
oral quetiapine versus risperidone LAI
1,0
0,9
0,8
0,7
0,6
0,5
Quetiapin oral
0,4
Risperidon LAI
0,3
0,2
0,1
0,0
0
90
180
270
360
450
540
630
720
days
810
Meta-analysis
Depot/LAI versus oral antipsychotic treatment
RR
(95% CI Random)
RR
(95%CI Random)
n/N
Control
n/N
Barnes 1983
3/19
3/17
Falloon 1978
8/20
5/24
Hogarty 1979
22/55
32/50
Quitkin 1978
5/29
Rifkin 1977
1/19
4/24
Crawford 1974
2/14
6/15
21/27
59/61
Schooler 1973
26/107
35/107
Total (95%CI)
88/290
Study
Treatment
update
2010 preliminary:
4/27
1-year relapse rates
146/325
depot
treatment ~ 25%
Favours control
Mentschel et al. 2003 Presented at: 156th meeting of the American Psychiatric Association
Percent of psychiatrists
100
90
80
70
60
50
40
30
20
10
0
Depot/LAI
Oral
81
62
36
11
35% vs
35%
35% vs
30%
35% vs
25%
35% vs
20%
FEP
Is a compliance challenge there
from the very start?
Myths vs Facts #3
1.
2.
3.
4.
5.
6.
7.
8.
100
90
80
70
60
50
40
30
20
10
0
risperidone LAI
risperidone oral
100
90
80
70
60
50
40
30
20
10
0
39
11
risperidone LAI
risperidone oral
FEP
Results from a 2-year trial from South Africa
Conclusions
Depot/LAI therapy is still rather an exceptional approach
than a routine treatment strategy
despite considerable advantages