Antipsychotics are the mainstay in
schizophrenia management, and long-acting
injectable (LAI)
antipsychotics contribute to the successful maintenance of treatment by improving non-adherence and preventing relapses.
Paliperidone palmitate 3-monthly (PP3M) formulation is the only available LAI
antipsychotic that offers an extended 3-month window of stable plasma drug concentration, enabling only four
injections per year. This paper summarizes clinically relevant endpoints from available evidence for PP3M to bridge translational research gaps and provide measurable outcomes that can be interpreted in clinical practice. Low number-needed-to-treat (NNT) for
relapse prevention (NNT [95% CI] 6-month estimate: 4.8 [3.2; 10.0]; 12-month estimate: 3.4 [2.2; 7.0]), and high number-needed-to-harm (NNH [95% CI]
akathisia, 27.1 [12.3; -667.1];
tremor, 80.0 [22.5; 67.3];
dyskinesia, -132.6 [44.5; -23.2];
parkinsonism, 160.0 [28.9; -49.8]) quantify the relative benefits and low propensity for adverse events with PP3M. Symptom remission and reductions in positive and negative symptoms indicate treatment stability. Additionally, meaningful functional remission, reduced dosing frequency, and freedom from daily negotiations favorably impact patient preference and attenuate burdensome aspects of caregiving, representing important healthcare determinants that enhance prospects of treatment continuity in
schizophrenia. This information can potentially improve clinicians' judgment of treatment choices, clinical response, and patient selection in routine care. Taken together, PP3M is a valuable
antipsychotic treatment option, meriting consideration for a broader role in the long-term management of
schizophrenia; its utility should not be limited to patients with poor adherence or when oral
antipsychotics have failed.