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

Research output: Contribution to journalArticle

Pierre-Michel Llorca, Julio Bobes, W. Wolfgang Fleischhacker, Stephan Heres, Nicholas Moore, Nawal Bent-Ennakhil, Christophe Sapin, Jean-Yves Loze, Anna-Greta Nylander, Maxine X. Patel

Original languageEnglish
Pages (from-to)85-94
Number of pages10
JournalEuropean Psychiatry
Early online date4 May 2018
Accepted/In press7 Apr 2018
E-pub ahead of print4 May 2018
PublishedAug 2018


King's Authors


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For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI.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.

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