TOPLINE:

Long-acting injectable antipsychotics (LAIs), particularly second-generation formulations, were associated with greater reductions in 30-, 60-, and 90-day hospital readmission rates compared with oral antipsychotics (OAs) in adult patients with bipolar I disorder (BD-I), new research showed.

METHODOLOGY:

• A retrospective cohort study included data on more than 98,000 US adults hospitalized with BD-I between 2020 and 2023.
• About 78% of participants received OAs on the day of or day before discharge and 2% received LAIs during their hospital stay. (The remaining participants received a mood stabilizer or none of these medications.) A subgroup analysis included patients discharged on second-generation LAIs.
• LAI and second-generation LAI users were propensity-score matched with OA users (~50% women; mean age, 36-38 years across the groups).
• The primary outcomes included BD-I-related and all-cause rehospitalization rates within 30, 60, and 90 days following the index hospitalization, and risk for rehospitalization. Exploratory outcomes included rates of medication continuation vs switching at the first rehospitalization and rates of subsequent rehospitalization.

TAKEAWAY:

• BD-I-related rehospitalization rates were significantly lower for LAI users than for OA users within 30 days (4% vs 5%; P = .03) and 60 days (6% vs 7%; P = .03), and rates for second-generation LAI users were lower at 30 days (4% vs 5%; P = .01), 60 days (5% vs 7.5%; P = .008), and 90 days (7% vs 9%; P = .015).
• The LAI group had a lower risk for BD-I-related rehospitalization than the OA group within 30 days (hazard ratio [HR], 0.78; P = .03) and 60 days (HR, 0.82; P = .03), while second-generation LAI group had a lower risk at 30 days (HR, 0.65; P = .01), 60 days (HR, 0.69; P = .009), and 90 days (HR, 0.74; P = .02).
• For all-cause rehospitalizations, second-generation LAI users had a lower risk than OA users at 60 days (HR, 0.80; P = .04) and 90 days (HR, 0.81; P = .02), but differences for the overall LAI group were not statistically significant.
• Among patients discharged on OAs, 84%-86% continued OA treatment at rehospitalization. In contrast, only 39%-41% of LAI users and 35%-37% of second-generation LAI users continued injectable therapy within 30-90 days of rehospitalization.

IN PRACTICE:

“The findings underscored the potential of LAIs in reducing the burden on healthcare resources and their potential in improving BD-I management. Underutilization of LAIs for BD-I treatment in clinical practice highlights a critical gap that warrants further investigation,” the investigators wrote.

SOURCE:

This study was led by Sigal Kaplan, PhD, Teva Pharmaceutical Industries Ltd, Netanya, Israel. It was published online on March 2 in The Journal of Clinical Psychiatry.

LIMITATIONS:

This study was limited by a potential risk for misdiagnosis because it included patients without a confirmatory second diagnosis of BD-I, and treatment decisions based on routine clinical practice may have introduced bias. Unmeasured factors such as disease severity, prior treatment history, and comorbidity profile limited the ability to fully control for confounders. Reliance on hospital discharge data may not have fully captured patient experiences, including community-based care, medication formulary restrictions, and medication adherence. The observation period coincided with the COVID pandemic, which may have affected LAI availability and administration due to social distancing and travel restrictions, and the study did not account for variations in clinician practices or patient preferences that could have affected treatment continuation and effectiveness.

DISCLOSURES:

This study was funded by Teva Branded Pharmaceutical Products R&D LLC. Five of the investigators reported being employees and/or shareholders of Teva Pharmaceuticals, and two others reported being employees of eMAX Health Systems. Other disclosures are fully listed in the original article. Some of the findings were presented previously at the 2025 Academy of Managed Care Pharmacy Annual Meeting.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.