Side effects and high nonadherence to oral antipsychotics in schizophrenia and bipolar disorder highlight the need to evaluate long-acting alternatives.

Schizophrenia and bipolar disorder are often linked to significant life disruption and increased risk of premature death, underscoring the need for improved patient-centered treatment strategies. Oral antipsychotics (OAs) have been considered the gold standard treatment for these conditions. While OAs can prevent relapse, they are associated with negative side effects (e.g., depression and motor side effects) and high nonadherence. 

Long-acting injectable antipsychotics (LAIAs) are a promising alternative that may address high nonadherence rates and improve clinical outcomes, such as reduced hospitalizations and relapse. Despite a growing body of research on LAIAs, we lack a recent synthesis on the current evidence comparing their effectiveness to OAs, limiting our understanding of their relative benefits and existing and potential evidence gaps. The changing mental health care landscape, including increased telehealth use and economic burden considerations, necessitates a scoping review on the impact of LAIAs, including clinical and patient-centered outcomes.

NORC is conducting a scoping review to synthesize evidence comparing LAIAs with OAs for schizophrenia and bipolar disorder treatment.

In consultation with the Patient-Centered Outcomes Research Institute (PCORI), NORC is conducting a rigorous scoping review to synthesize current evidence on the comparative effectiveness of LAIAs and OAs for treatment of schizophrenia and bipolar disorder. Leveraging expertise in evidence synthesis and patient-centered comparative effectiveness research, NORC will address the following stakeholder-informed key questions:

• How do LAIAs and OAs compare in improving clinical outcomes like symptom management and relapse prevention?

• What are the economic and quality-of-life impacts of each treatment from different stakeholder perspectives?

• How do safety and side effects differ between LAIAs and OAs?

• What factors influence treatment decisions, including patient preferences and access to care? 

• How do study designs and populations affect interpretation of findings?

NORC will engage patients, clinicians, researchers, and others to contextualize the current use of LAIAs and gather considerations not documented in the literature. Findings will be synthesized with the latest evidence comparing LAIAs and OAs for treating schizophrenia and bipolar disorder to address the key questions.

NORC’s long-standing collaboration with PCORI and engagement of clinical experts will ensure that this work is rigorous and aligned with PCORI’s mission. This effort demonstrates NORC’s ability to translate complex evidence into actionable insights that support real-world decision-making.