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.