Long-acting injectable antipsychotics linked to reduced short-term disruptive life event and death

Long-acting injectable antipsychotics (LAI) may be beneficial for patients with schizophrenia (SCZ) or bipolar I disorder (BPI) compared with oral antipsychotics. We aimed to assess the association of LAI use on all-cause mortality and disruptive life events (DLE) among patients recently diagnosed with SCZ or BPI. We conducted a retrospective cohort study using adult patients meeting study eligibility criteria in Kaiser Permanente Southern California (KPSC) during 2007–2019. The index event for cohort entry was the first mental health related emergency department or inpatient encounter after initial diagnosis of SCZ or BPI. Two study arms were defined by the medication history within 180 days after index events: received LAI (LAI arm) and received oral antipsychotics only (oral-only arm). Unadjusted and adjusted two-sample comparisons were performed, where adjusted analyses used propensity score matching to balance observed characteristics. Outcomes were occurrence of specific DLEs (arrests, bankruptcy, and judgment filings), occurrence of any DLE, and all-cause mortality during the year after index events. The cohort had 3,667 patients in the oral-only arm and 218 in the LAI arm. Compared with the oral-only arm, the LAI arm had lower risks in all outcomes qualitatively. The rarity of the outcome and limited sample size in the LAI arm limited statistical power: adjusted risk difference was -1.68% for occurrences of any DLE (95% CI: -3.44%, 0.08%, p < 0.10), and -0.46% for all-cause mortality (95% CI: -0.98%, 0.06%, p < 0.10). Patients with SCZ or BPI taking LAIs may be associated with lower risk of DLE and mortality within the one-year period after index than those who took oral antipsychotics only. Larger studies are needed to further confirm these associations.