Long-acting antipsychotics and mortality in patients with schizophrenia receiving homecare case management.

Aim: Long-acting injectable antipsychotics (LAIs) offer several advantages over oral antipsychotic medications for treating schizophrenia. However, whether the benefits of LAIs extend to patients receiving homecare case management (CM) remains unclear.

Methods: This cohort study used Taiwan's National Health Insurance Research Database, enrolling 19,680 nationwide patients with schizophrenia who began homecare CM between January 1, 2000, and December 31, 2019. Each patient was followed for 5 years or to the data censored, with 30-day periods serving as follow-up units. We evaluated LAI and other medication usage during each period and their associations with mortality outcomes. Additionally, we investigated whether consistent users of homecare CM services (maintenance group) receiving specific LAI treatments had better prognoses.

Results: In the cohort (n = 19,680), 6428 received first-generation antipsychotic long-acting injectables (FGA-LAIs) and 4954 received second-generation antipsychotic long-acting injectables (SGA-LAIs). The FGA-LAI group had a mean age of 39.27 years (55.13% male), while the SGA-LAI group had a mean age of 41.25 years (53.75% male). Of 1366 deaths within 5 years, 980 were from natural causes and 254 from suicide. FGA-LAIs reduced natural mortality (HR: 0.67, P = 0.001) but increased suicide risk (HR: 1.52, P = 0.01). SGA-LAIs lowered all-cause (HR: 0.53, P < 0.001) and natural mortality (HR: 0.42, P < 0.001) without affecting suicide mortality (HR: 0.82, P = 0.384). In the maintenance group, FGA-LAIs showed no mortality benefit and increased suicide risk (HR: 2.07, P < 0.001), while SGA-LAIs consistently reduced all-cause (HR: 0.39, P < 0.001), natural (HR: 0.31, P < 0.001), and suicide mortality (HR: 0.54, P = 0.034).

Conclusions: SGA-LAIs could be a preferable treatment for reducing mortality in patients with schizophrenia receiving homecare CM, particularly for those in the maintenance group.