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Aim  Long‐acting injectable antipsychotics ( APs ) are not well studied in recent‐onset schizophrenia. This exploratory analysis of a study designed to reflect real‐world schizophrenia, as defined by patients, interventions and outcomes, compared relative treatment effect between once‐monthly paliperidone palmitate ( PP ) and daily oral  APs  in patients with recent‐onset or chronic illness    Methods  This randomized, open‐label, event monitoring board–blinded study compared treatment response in subjects with schizophrenia and a history of criminal justice system involvement following treatment with  PP  or oral  APs  for 15 months ( ClinicalTrials.gov  identifier,  NCT 01157351). Event‐free probabilities were estimated using  K aplan– M eier method; hazard ratios ( HRs ) were estimated using Cox proportional hazard models. This subgroup analysis analysed data by disease duration (≤5 (recent‐onset) or >5 years (chronic illness) since first psychiatric diagnosis).    Results  Seventy‐seven subjects met the criteria for recent‐onset illness; 365 for chronic illness.  HRs  (95%  CI ) for treatment failure for oral  APs  versus  PP  were 1.73 (0.87–3.45;  P  = 0.121) for recent‐onset and 1.37 (1.02–1.85;  P  = 0.039) for chronic illness. Most common adverse events for  PP  versus oral  APs  were injection site pain (recent‐onset, 26% vs. 0%; chronic, 17% vs. 0%), increased weight (14% vs. 6%; 12% vs. 6%), akathisia (14% vs. 9%; 10% vs. 7%), insomnia (12% vs. 17%; 18% vs. 10%) and anxiety (12% vs. 6%; 10% vs. 8%).    Conclusions  Although neither pre‐planned nor adequately powered, the estimated  HRs  suggest that the relative advantage of  PP  over oral  APs  for reducing the risk for treatment failure may be greater in patients with recent‐onset schizophrenia than in those with more chronic illness.

early intervention in psychiatry

Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement