F114. THE EVOLUTION OF LONG-ACTING ANTIPSYCHOTICS USE IN QUEBEC BETWEEN 2003 AND 2017

Long-acting injectable antipsychotics (LAIs) are recommended to decrease relapse in SZ and their relevance is acknowledged in every treatment guideline available internationally. Yet their rate of use is reported to be very low (6%) in Canada, based on a paper by Williams et al. It could be hypothesized that the fact that second generation LAIs (SGA-LAIs) had just become available might have accounted for these modest rates of use, given the strong inclination of clinicians to prefer prescribing SGAs, that had been previously available only in an oral form. However, this paper dates were published in 2006, and we are unaware from any other data on possible changes in LAI used that could have occurred following the increasing availability of new second-generation LAIs or after the publication of Québec and Canada recommendations of experts. The present report examines the changes in rates of LAIs in Québec from 2003 until 2017. We obtained from the number of LAIs prescriptions reimbursed for each month from 2003 to 2017 by the provincial public insurance system that provides coverage to more than 90% of people suffering from a psychotic disorder. As this data set was obtained from a commercial entity (IMS), it did not include any information on the individuals receiving this LAIs. Hence, we computed their rate of use per 1000,000 people, taking into account the increase in Québec population over that period. In the absence of any diagnostic information, change in number of prescription might reflect changes in their use in diagnostic categories other that SZ and related psychotic disorder. To address this, we performed sensitivity analyses that will be detailed below. Over the studied period, the rate of use of LAIs more than tripled, going from 32,4/100 000 in 2003 to 99,6 per 100 000 in 2016. The use of first-generation LAIs decreased from 33,6 per 100 000 in 2003 to 24,5 per 100 000 in 2017. The use of second-generation LAIs (SGA-LAIs), first introduced in 2003 (Risperidone-Consta), reached 75,1/100,000 in 2017. Further analyses of changes in rates of use started in 2004, a few months after the introduction of the first SGA-LAI and increased in a linear pattern over the period of the study, without any significant inflection point over that period. These data show that LAI use in Québec has increased steadily since 2004, and that this use seems to coincide with the introduction of the first SGA-LAI, without further increase co-occurring with the publication and dissemination of expert recommendations. This supports the hypothesis that the modest rates of use of LAIs that was previously reported in Québec and Canada might have resulted from the fact that only FGA were available in the LAI form while SGAs had become the mainstay in pharmacological treatment of psychotic disorders. However, the lack of diagnostic information on the persons who have used these LAIs prevent concluding about their current rates of use in people suffering from SZ and related psychotic disorders as well as on the variations of these rates over the study period. To address these limitations, we are currently planning further analyses based on the public health care system that will combine information of medication use and diagnostic information on the people with whom these medications are used.

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