Clinical Practice Recommendations for Switching from Once-Monthly to Longer-Interval Paliperidone Palmitate Injectable in Schizophrenia Patients: A Modified Delphi Study in China

Purpose Schizophrenia is a chronic mental disorder with substantial socioeconomic burden. Long-acting injectable antipsychotics (LAIs) demonstrate superior efficacy over oral antipsychotics in reducing relapse and improving adherence. Switching from short-interval LAIs (such as paliperidone palmitate one-month formulation, PP1M) to longer-intervals LAIs (like paliperidone palmitate three-month and six-month formulations) offers additional benefits to disease outcome. This modified Delphi study aimed to explore clinical consensus on switching strategies to longer-interval LAIs.

Patients and Methods A steering committee of six psychiatrists experienced LAIs treatment in schizophrenia guided questionnaire design and consensus alignment. Thirteen panelists participated in two Delphi rounds. A targeted literature review (TLR) was conducted to generate key topics, preliminary statements and open-ended questions for steering committee interviews. A total of 37 statements were finalized for Delphi. Two Delphi rounds were conducted via one-on-one interviews (Nov-Dec 2024). Each statement was rated following a nine-point Likert scale. Measures of central tendency and variation were calculated. Consensus levels were categorized as "Strong/Moderate/Nearing/No Consensus". Qualitative analyses were performed to refine statements. A final virtual meeting with steering committee confirmed consensus.

Results In the two Delphi rounds, 35 statements reached strong consensus, one moderate consensus, and one nearing consensus. After reviewed by the six steering committee experts, four semantically statements were removed, yielding a final set of 33 consensus statements. Intraclass correlation coefficient improved from 0.674 to 0.751.

Conclusion Final consensus was reached on 33 statements across five domains: clinical necessity, target patient populations, switching strategy, long-term disease management, factors influencing treatment willingness. It presents the first expert consensus in China on longer-interval LAIs usage in schizophrenia, offering evidence-informed guidance for patient selection, switching strategies and long-term disease management to promote standardized clinical use.