Work

156. Clinical Practice Recommendations for Switching to Longer-interval Injectable Antipsychotics in Schizophrenia Patients: a Modified Delphi Study in China

Year: 2025

Type: article

Abstract: Background Schizophrenia is a chronic mental disorder, often accompanied by varying degrees of mental disability, which leads to a significant socioeconomic burden[1]. In the management of schizophrenia, long acting injectables (LAIs) have demonstrated superiority in reducing the risk of relapse and improving medication adherence compared to oral antipsychotics[2]. Furthermore, the benefits can be amplified in patients who switch from short-interval LAIs, such as paliperidone palmitate one-month formulation (PP1M), to longer-interval LAIs, such as paliperidone palmitate three-month formulation (PP3M) or six-month formulation (PP6M)[3-5]. However, the use of longer-interval LAIs is underutilized in China, partly due to the absence of clinical application guidance. Aims & Objectives This study aims to explore optimal practice for switching from PP1M to PP3M among patients with schizophrenia and expects to provide instructions for clinical application of longer-interval LAIs. Method The study used a three-step modified Delphi panel method to investigate the clinical practice of switching to longer-interval LAIs in patients with schizophrenia. The statements in the Delphi questionnaire were developed through a targeted literature review (TLR) and in-depth individual discussions with the steering committee of six experienced psychiatrists. After finalizing all statements, two rounds of Delphi panel were conducted with the panelists via virtual 1:1 interview meeting to obtain ratings on the extent of their agreement and feedback on each statement. Finally, a face-to-face workshop with steering committee will be held to form the final expert consensus. Measures of central tendency (mean, median) and variability (interquartile range) will be reported back to help panelists assess their previous responses. Results Two groups of experienced psychiatrists, including 6 steering committee members and 13 panelists, were recruited. 37 statements have been established after TLR and in-depth interview with steering committee, which include five categories: clinical necessity and potential benefits of longer-interval LAIs (8 statements), target patients (6 statements), switching strategies (9 statements), long-term disease management (9 statements), and factors influencing willingness to use longer-interval LAIs (5 statements). After the first round of Delphi panel, 37 statements achieved ≥ 80% agreement (considered consensus). The coefficient of variation (CV) of these statements ranged from 0.042 to 0.226. The Kendall coefficient of concordance was 0.211 (p< 0.001), indicating a good level of expert coordination. Although all statements reached consensus after the first round of the Delphi process, the panelists provide numerous suggested modifications for the statements. These revised statements will be evaluated in the second round Delphi, and the outcomes will be finalized following the consensus meeting. Discussion & Conclusions The findings from the current result support the application of longer-interval LAIs for stable schizophrenia patients. The recommendations aim to optimize the use of longer-interval LAIs and are expected to enhance the outcomes for patients with schizophrenia in China.

Source: The International Journal of Neuropsychopharmacology

DOI: 10.1093/ijnp/pyaf052.006