Long‐Acting Injectable Antipsychotic Use and Discontinuation Rates in Children and Adolescents With Schizophrenia Using Medicaid Claims Data

PMCID: PMC12172391

PMID: 40525645

DOI: 10.1111/eip.70063

Journal: Early intervention in psychiatry

Publication Date: 2025-6-17

Authors: Ward TM, Xu J, Hall DB, Chen X, Benavides S, et al.

Key Points

• LAI antipsychotics represent an emerging treatment strategy for pediatric psychiatric populations, potentially improving medication adherence
• Paliperidone palmitate showed a statistically significant 46% higher discontinuation risk in Black patients (HR = 0.54, p = 0.01)
• Racial differences in medication tolerability and side effect profiles warrant careful clinical monitoring and personalized treatment approaches

Summary

This retrospective study examined long-acting injectable (LAI) antipsychotic prescribing patterns and discontinuation rates among children and adolescents with schizophrenia and related disorders using Medicaid claims data. Analyzing 1,277 patients aged 7-17 years, the research revealed that second-generation LAI antipsychotics were predominantly prescribed, with paliperidone palmitate (40%) and aripiprazole formulations (48%) being the most common.

A critical finding was the racial disparity in medication discontinuation, specifically for paliperidone palmitate. White patients demonstrated a 46% lower hazard of discontinuation compared to Black patients (HR = 0.54, p = 0.01). While the underlying reasons remain unclear, potential factors may include differential susceptibility to extra-pyramidal symptoms, metabolic side effects, or caregiver burden, highlighting the need for further investigation into racial variations in antipsychotic treatment responses.