¹University of Debrecen, School of Medicine, Debrecen, Hungary, ²E-Da Hospital, Department of Psychiatry, Kaohsiung, Taiwan, ³I-Shou University, School of Medicine, College of Medicine, Kaohsiung, Taiwan

Background: Long-acting injectable (LAI) antipsychotics have been extensively utilized in the treatment of individuals with bipolar I disorder (BPD).

Aims & Objectives: This study aimed to evaluate and compare the effectiveness of LAI aripiprazole versus oral medications in preventing relapse of BPD in real-world clinical practice.

Method: This cohort study was conducted from 2014 to 2024 at a university hospital in Taiwan. Participants were divided into two groups based on their naturalistic treatment: the oral medication group and the LAI aripiprazole group. Data collected included age, sex, previous hospitalization history, and previous psychiatric emergency history. Patients were monitored until the end of the study or the occurrence of a relapse, indicated by re-hospitalization or emergency. Kaplan-Meier survival analysis and Cox proportional hazard modeling were employed to analyze outcomes.

Results: Table 1 shows that the LAI group had significantly more previous admissions and emergencies compared to the oral medication group, and a higher rate of relapse according to Kaplan-Meier statistics (log rank p<0.001). Figure 1 illustrates that the LAI group exhibited an increased but attenuated risk of relapse compared to the oral group (HR 1.7, 95% CI 1.1 to 2.8, p=0.03).

	number	mean age (SD) years	mean previous admission (SD)	mean previous emergency (SD)	mean months to end of admission (SD)	admission event/censored (%)	mean months to end of emergency (%)	emergency event/censored (%)
Oral	881	45.2 (15.2)	0.1 (0.5)	0.2 (0.9)	100.3 (1.0)	105/776 (88.1)	49.3 (1.6)	427/454 (51.5)
LAI	83	46.8 (15.0)	0.6 (0.8)	0.4 (0.9)	54.4 (2.8)	21/62 (74.7)	25.6 (2.9)	47/36 (43.4)
Total	964	45.3 (15.2)	0.2 (0.6)	0.2 (0.9)	99.0 (1.0)	126/838 (86.9)	47.7 (1.6)	474/490 (50.8)

Discussion & Conclusions: Patients with a clinically unstable course of BPD may benefit from LAI aripiprazole; however, their prognosis is not as favorable as that of patients with a more stable course.