It is likely that aripiprazole prolonged-release injection will be used as an alternative treatment option to the currently available second-generation prolonged-release depot antipsychotics for maintenance treatment for schizophrenia in adults.
The NICE clinical guideline on psychosis and schizophrenia in adults recommends that treatment with antipsychotic medication should be considered an explicit individual therapeutic trial. It also recommends that the choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees. Information should be provided on, and there should be discussion about, the likely benefits and possible side effects of each drug, including metabolic, extrapyramidal, cardiovascular, hormonal and other side effects (including unpleasant subjective experiences). The BNF chapter on antipsychotic drugs describes the relative efficacy and adverse effects of different antipsychotics. A National Prescribing Centre patient decision aid provides a guide to the relative adverse effects of different antipsychotics, based on information available at that time (2009).
The dosing schedule of aripiprazole prolonged-release injection has potential advantages over some currently available depot antipsychotics because it is given monthly rather than fortnightly and initial dose titration is not needed.
Local decision makers will need to consider the available evidence on efficacy and safety, as well as cost and individual factors for people with schizophrenia, when making decisions about using aripiprazole prolonged-release injection. The publication of head-to-head studies comparing the efficacy and adverse event profile of aripiprazole prolonged-release injection with other antipsychotics, including the less costly first-generation antipsychotic depot injections, would facilitate a better understanding of its place in the treatment of schizophrenia.
The manufacturer estimates that 15,245 people in England are currently receiving a second-generation prolonged-release antipsychotic for maintenance treatment for schizophrenia. They predict that 4% of those eligible for treatment with these drugs will receive aripiprazole prolonged-release in year 1 rising to 8% in year 2 and 12% in year 3 (Otsuka Pharmaceutical Limited: personal communication, January 2014).