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Baseline results from the European non-interventional Antipsychotic Long acTing injection in schizOphrenia (ALTO) study.

  • Llorca, Pierre-Michel1
  • Bobes, Julio2
  • Fleischhacker, W Wolfgang3
  • Heres, Stephan4
  • Moore, Nicholas5
  • Bent-Ennakhil, Nawal6
  • Sapin, Christophe6
  • Loze, Jean-Yves7
  • Nylander, Anna-Greta8
  • Patel, Maxine X9
  • 1 University Hospital Center, EA 7280 University Clermont Auvergne, Clermont-Ferrand, France. , (France)
  • 2 Department of Psychiatry - CIBERSAM, University of Oviedo, Oviedo, Spain. , (Spain)
  • 3 Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry, Medical University Innsbruck, Innsbruck, Austria. , (Austria)
  • 4 Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany. , (Germany)
  • 5 Department of Pharmacology, University of Bordeaux, Bordeaux, France. , (France)
  • 6 Lundbeck SAS, Issy-les-Moulineaux, France. , (France)
  • 7 Otsuka Pharmaceutical Europe Ltd., Wexham, United Kingdom. , (United Kingdom)
  • 8 H. Lundbeck A/S, Ottiliavej 9, Valby, 2500, Denmark. Electronic address: [email protected] , (Denmark)
  • 9 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. , (United Kingdom)
Published Article
European psychiatry : the journal of the Association of European Psychiatrists
Publication Date
Aug 01, 2018
DOI: 10.1016/j.eurpsy.2018.04.004
PMID: 29734130


The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs. Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life. For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight. These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication. Crown Copyright © 2018. Published by Elsevier Masson SAS. All rights reserved.

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