Second-Generation Long-Acting Injectable Antipsychotics: A Comprehensive Assessment of Effectiveness, Safety, and Cost.

Abstract

Background: Second-generation long-acting injectable antipsychotics (SG-LAIs) improve adherence, reduce relapse, and enhance outcomes in schizophrenia, yet remain underused. In Romania, data on psychiatrists' views is limited.

Objective: To assess Romanian psychiatrists' attitudes and prescribing behaviors regarding SG-LAIs, and identify key drivers and barriers to their use.

Methods: We conducted a cross-sectional questionnaire survey among psychiatrists in urban hospital, outpatient, and private settings, treating more than 1,000 patients with schizophrenia. The survey rated the four SG-LAIs available in Romania (aripiprazole, olanzapine, paliperidone, and risperidone) on efficacy, tolerability, dosing flexibility, monitoring needs, prescribing frequency, and perceived obstacles/facilitators.

Results: 80 psychiatrists participated. Aripiprazole LAI received the most favorable ratings, ranking highest for efficacy, safety, patient functioning, ease of administration, guideline alignment, side-effect profile, monitoring requirements, and overall preference. Paliperidone and risperidone were also positively evaluated for dosing versatility, whereas olanzapine generally scored lowest. Main factors encouraging LAI prescription were improved adherence (96.3%) and reduced relapse risk (96.3%), followed by a favorable clinical profile (66.3%). Key barriers included lack of patient trust (57.5%), lack of hospital supply (43.8%), absence of LAI formulations for certain antipsychotics (43.8%), and limited experience (36.3%).

Conclusion: Romanian psychiatrists show a strong preference for aripiprazole LAI, with decisions driven mainly by clinical benefits. Reducing patient concerns and system-level limitations-especially availability, indications, and communication- may support increased use of SG-LAIs in everyday clinical care.