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Therapeutic drug monitoring of LAI antipsychotics as a predictor of clinical relapse: a one-year follow-up

Published online by Cambridge University Press:  01 September 2022

G. D’Anna ,
F. Rotella ,
A. Ballerini  and
V. Ricca
G. D’Anna*
Affiliation:
University of Florence, Department Of Health Sciences, Florence, Italy
F. Rotella
Affiliation:
University of Florence, Department Of Health Sciences, Florence, Italy
A. Ballerini
Affiliation:
University of Florence, Department Of Health Sciences, Florence, Italy
V. Ricca
Affiliation:
University of Florence, Department Of Health Sciences, Florence, Italy
*
*Corresponding author.

Abstract

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Introduction

Clinical relapses in schizophrenia remain a frequent event. Long-acting injectable (LAI) antipsychotics enhance adherence, but low blood levels can sometimes be observed despite an adequate posology. Nonetheless, the evaluation of this parameter is uncommon in clinical practice.

Objectives

To explore the potential advantages of therapeutic drug monitoring (TDM) of LAIs as a predictor of relapse in clinically stable outpatients with schizophrenia.

Methods

44 individuals who had reached the pharmacokinetic steady state of LAI treatment (paliperidone, olanzapine, aripiprazole) underwent an anamnestic and psychopathological assessment. LAI blood levels were measured using liquid chromatography-mass spectrometry and classified as “in range” or “under range” according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guideline values. Individuals who relapsed during the one-year follow-up were compared to non-relapsers (Fisher’s exact test, χ2 or Mann-Whitney U). An exploratory binary logistic regression tested the role of other possible relevant predictors of relapse.

Results

No differences were observed in baseline use of mood stabilisers (p=0.211), antidepressants (p=0.530), or prescribed LAI (p=0.563). Other comparisons are presented in the table: among these variables, in-range LAI levels were the only significant predictor of relapse (F=5.95, p=0.015; OR 0.04, 95%CI 0.02-0.56).

Relapse (n=6)No relapse (n=38)p
Age (years)41.33±10.7843.95±12.980.667
Male4 (66.7%)21 (55.3%)0.600
Illness duration (years)21.83±2.6419.13±11.820.289
Previous acute episodes3.50±1.053.29±1.470.652
PANSS-total49.33±14.8342.74±14.140.231
In-range LAI2 (33.3%)32 (84.2%)0.006

Conclusions

TDM of LAIs may optimise the clinical management of schizophrenia by highlighting a suboptimal dosage and a consequent higher relapse risk. Large-scale, drug-specific assessments are needed to confirm these findings.

Disclosure

No significant relationships.

Keywords

schizophréniaLAIRelapseTherapeutic drug monitoring
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S198
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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