The LAI–Oral Antipsychotic Efficacy–Effectiveness Paradox in Schizophrenia

Background and Objectives: Long-acting injectable (LAI) antipsychotics are associated with reduced hospitalization and relapse in real-world observational studies of schizophrenia; however, randomized controlled trials (RCTs) demonstrate no statistically significant advantage over oral antipsychotics for relapse prevention. This efficacy–effectiveness paradox has remained unresolved in the literature for decades and has directly contributed to the persistent underutilization of LAIs in clinical practice.