2026 ECNP Congress

PS01-1060

Trends in outpatient prescribing of long-acting injectable antipsychotics among patients diagnosed with schizophrenia in Germany (2012–2021)

Mishal Qubad — O.H.F. Scholle, B. Kollhorst, O. Riedel, C.J. Bachmann, R.A. Bittner · Goethe University Frankfurt, Department of Psychiatry- Psychosomatic Medicine and Psychotherapy- University Hospital Frankfurt, Frankfurt/Main, Germany

2026 ECNP Congress

Introduction

Antipsychotics represent the cornerstone of treatment approaches in schizophrenia to achieve and maintain symptomatic remission and especially to reduce relapse risk.[1] Non-adherence to treatment is one of the main factors contributing to high relapse rates, which in turn are associated with poorer long-term functional outcome. Long-acting injectable antipsychotics (LAIs) were introduced to improve adherence in patients with schizophrenia.[1] LAI use has been associated with reduced relapse risk, lower hospitalisation risk, lower overall healthcare costs, lower all-cause mortality rates and better functional outcomes.[2] Overall, current evidence supports broader use of LAIs.[2] International studies indicate that LAI use among schizophrenia patients varies across countries, with reported rates between 15% and 50% in most high-income settings.[3,4,5] Data on trends in the utilisation of LAIs in routine care in Germany are lacking. Against this background, examining prescription prevalence in German claims data may help to characterise the extent to which LAIs are used in routine outpatient care and to illustrate how prescribing patterns have changed over time.

Aims

This study aimed to describe trends in the use of LAIs among persons with schizophrenia between 2012 and 2021 in Germany.

Methods

Based on claims data covering about 20% of the German population (GePaRD), we conducted repeated cross-sectional analyses for the years 2012–2021. For each year, we included patients with a diagnosis of schizophrenia and at least one prescription for a schizophrenia-recommended antipsychotic. Among these patients, we calculated the prevalence of outpatient LAI use and assessed the proportion of LAI prescriptions by pharmaceutical agent.

Results

In each study year, we included between 43,481 and 45,616 individuals with treated schizophrenia. Between 2012 and 2021, the overall age- and sex-standardized prevalence of LAI use ranged from 15.5% (95% confidence interval [CI] 15.2–15.9) to 16.5% (95% CI 16.1–16.8). In 2021, utilisation was 13.4% (95% CI 12.9–13.8) among females and 17.7% (95% CI 17.2–18.1) among males. Moreover, utilisation was 14.3% (95% CI 13.8–14.8) in large urban cities and 18.5% (95% CI 17.5–19.6) in sparsely populated rural regions. Across time, in both sexes, the prevalence of LAI use increased in patients aged 20–44 years and decreased in those aged 45–64 years. In 2021, most LAI prescriptions in adult patients (18–64 years) were for paliperidone (47%), followed by aripiprazole (23%), risperidone (11%), and flupentixol (10%). Across the study period, the relative share accounted for by paliperidone and aripiprazole increased substantially, whereas the corresponding shares of risperidone, flupentixol and haloperidol decreased.

Conclusions

We found that about one in six outpatients with schizophrenia receiving antipsychotic treatment received an LAI prescription during the study period. This finding suggests that, compared to most other industrialised countries, the prevalence of LAI use in Germany is rather low. At the same time, prescribing patterns changed at the substance-class level, with first-generation antipsychotic LAIs declining over time, whereas use of second-generation LAIs increased. Given the clear benefits of LAI treatment, future research should investigate factors impeding and facilitating LAI prescribing in Germany.

References

  1. Leucht, S., Siafis, S., McGrath, J.J. et al. Schizophrenia. Nat Rev Dis Primers 11, 83 (2025). https://doi.org/10.1038/s41572-025-00667-6
  2. Kane JM, Agid O, Castle DJ, et al. The Use of Long-Acting Injectables for People with Schizophrenia: Consensus Panel Recommendations for Overcoming Barriers and Implementing Treatment. Neurol Ther. 2025;14(6):2551-2581. doi:10.1007/s40120-025-00838-3
  3. Agid O, Remington G, Fung C, Nightingale NM, Duclos M, Anger GJ. Real-World Utilization Patterns of Long-Acting Injectable Antipsychotics in Canada: A Retrospective Study. Can J Psychiatry. 2022;67(3):226-234. doi:10.1177/07067437211055413
  4. Tang CT, Chua EC, Chew QH, et al. Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region. Asia Pac Psychiatry. 2020;12(4):e12393. doi:10.1111/appy.12393
  5. Manchanda R, Chue P, Malla A, et al. Long-acting injectable antipsychotics: evidence of effectiveness and use. Can J Psychiatry. 2013;58(5 Suppl 1):5S-13S. doi:10.1177/088740341305805s02