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LB-102

Schizophrenia

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345 sources

Product information and disease descriptionPlace of product in therapyApproaches to treatment

Care management intervention strategies

12 evidence topics · 15 sources

Coordinated specialty care for first-episode psychosis

“APA recommends (1B) that patients with schizophrenia who are experiencing a first episode of psychosis be treated in a coordinated specialty care program.” (opens the source at this quote in a new tab)

“Participants (mean age 23) with schizophrenia and related disorders and ≤6 months antipsychotic treatment (N=404) were enrolled and followed for ≥2 years.” (opens the source at this quote in a new tab)

“NAVIGATE participants with duration of untreated psychosis <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in Community Care.” (opens the source at this quote in a new tab)

Assertive community treatment and intensive case management

“We recommend the use of service models based on standard Assertive Community Treatment in individuals with schizophrenia evidencing severe functional impairments and/or risk for repeated hospitalizations.” (opens the source at this quote in a new tab)

“When ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD ‐0.86, 95% CI ‐1.37 to ‐0.34,low‐quality evidence).” (opens the source at this quote in a new tab)

Long-acting injectable programs in early-phase illness

“In this cluster randomized trial of 489 participants, use of long-acting injectable aripiprazole monohydrate was associated with a significant delay in time to first hospitalization, with the number needed to treat to prevent 1 hospitalization of 7.” (opens the source at this quote in a new tab)

Clozapine: removal of the risk evaluation and mitigation strategy in 2025

“Food and Drug Administration (FDA) removed the risk evaluation and mitigation strategy (REMS) for clozapine (currently marketed as Clozaril, Versacloz, and generics), effective June 13, 2025.” (opens the source at this quote in a new tab)

“The removed REMS required enrollment of prescribers, pharmacies, and patients in a restricted distribution program and reporting of the level of certain white blood cells (i.e., the absolute neutrophil count (ANC)) to mitigate the risk of severe neutropenia.” (opens the source at this quote in a new tab)

“the Agency determined that the REMS was no longer necessary to ensure the benefits of clozapine outweigh the risk of severe neutropenia.” (opens the source at this quote in a new tab)

“Eliminating the REMS is expected to improve access to clozapine and decrease the burden on the health care delivery system.” (opens the source at this quote in a new tab)

Clozapine: neutrophil monitoring retained in labeling

“Prior to initiating CLOZARIL treatment, obtain baseline ANC(s).” (opens the source at this quote in a new tab)

“Frequent absolute neutrophil count (ANC) monitoring is necessary to identify neutropenia early so that health care professionals can intervene.” (opens the source at this quote in a new tab)

Metabolic monitoring during antipsychotic treatment

“Fasting blood glucose or HbA1c four months after initiating a new treatment and at least annually thereafter” (opens the source at this quote in a new tab)

“Lipid panel four months after initiating a new antipsychotic medication and at least annually thereafter” (opens the source at this quote in a new tab)

Management of antipsychotic-induced weight gain

“We suggest using metformin, topiramate, or aripiprazole augmentation for treatment of metabolic side effects of antipsychotic medication and weight loss for individuals with schizophrenia.” (opens the source at this quote in a new tab)

“We recommend that people with schizophrenia should be offered adjunctive metformin for the management of antipsychotic-induced weight gain.” (opens the source at this quote in a new tab)

Prior authorization of atypical antipsychotics: Maine Medicaid

“More than one-third of Medicaid programs and Medicare Part D plans use prior authorization (PA) policies to control the use of atypical antipsychotics (AAs).” (opens the source at this quote in a new tab)

“Patients initiating AAs during Maine's policy experienced a 29 percent greater risk of treatment discontinuity than patients initiating AAs before the policy took effect; no change occurred in a comparison state.” (opens the source at this quote in a new tab)

Formulary restrictions on atypical antipsychotics: 24 state Medicaid programs

“Patients with schizophrenia subject to formulary restrictions were more likely to be hospitalized (odds ratio 1.13, P <.001), had 23% higher inpatient costs (P <.001), and 16% higher total costs (P <.001).” (opens the source at this quote in a new tab)

Prior authorization and antipsychotic utilization in Medicaid

“We find that prior authorization requirements on atypical antipsychotics and other psychotherapeutics greatly reduced the utilization of these drugs and this reduction is not offset by substitution to other drugs in the same drug classes” (opens the source at this quote in a new tab)

“with the adverse consequence that fewer patients are receiving pharmacotherapy.” (opens the source at this quote in a new tab)

Step therapy for atypical antipsychotics: Georgia Medicaid

“Among patients with schizophrenia, the PA policy was associated with a USD 19.62 per member per month (PMPM) decrease in atypical antipsychotic expenditures and a USD 2.20 PMPM increase in typical antipsychotic expenditures (both, P < 0.001).” (opens the source at this quote in a new tab)

“the reduction in atypical antipsychotic expenditures was accompanied by a USD 31.59 PMPM increase in expenditures for outpatient services (P < 0.001).” (opens the source at this quote in a new tab)

State law limiting step therapy for serious mental illness: Colorado

“Effective January 1, 2025, with respect to step-therapy protocols (protocols) for health insurance, section 1 of the act defines "serious mental illness" and prohibits the protocols from requiring a person to try more than one prescription drug prior to receiving coverage for the drug prescribed by the person's health-care provider.” (opens the source at this quote in a new tab)

“The act requires the medical services board to require a review for coverage of a new drug approved by the federal food and drug administration for a serious mental illness within 90 days after the drug is approved.” (opens the source at this quote in a new tab)