Original ArticlesOff-label use of second-generation antipsychotics in borderline personality disorder: a comparative real-world study among oral and long-acting injectables in SpainGarcía-Carmona, Juan Antonioa,,b,,*; Simal-Aguado, Jorgec,,*; Campos-Navarro, María Pilard; Valdivia-Muñoz, Franciscoe,,f; Galindo-Tovar, AlejandrocAuthor Information aDepartment of Neurology, Santa Lucia University Hospital, Cartagena bUnit of Acute Psychiatry, Reina Sofía University Hospital cDepartment of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM dUnit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena eCentre of Mental Health Infante fCentre of Mental Health Cartagena, Cartagena, Murcia, Spain *Juan Antonio García-Carmona and Jorge Simal-Aguado contributed equally to the writing of this article. Received 19 January 2021 Accepted 2 March 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.intclinpsychopharm.com Correspondence to Juan Antonio García-Carmona, Department of Neurology, Santa Lucía University Hospital, C/Mezquita s/n, 30202, Cartagena, Murcia, Spain, Tel/fax: +34 968 110 859; e-mail: [email protected] International Clinical Psychopharmacology: July 2021 - Volume 36 - Issue 4 - p 201-207 doi: 10.1097/YIC.0000000000000357 Buy SDC Metrics Abstract The aim of the present study was to evaluate the use of oral vs. long-acting injectables (LAIs) antipsychotics, as well as, to compare the effectiveness of different LAI antipsychotics [aripiprazole-1-month, paliperidone-1-month (PP1M), paliperidone-3-month (PP3M) and risperidone long-acting injectable (RLAI)] in patients diagnosed with borderline personality disorder (BPD), by evaluating the following clinical outcomes: (1) the number of hospital admissions; (2) the number of documented suicidal behaviour/attempts; and (3) the use of concomitant treatments, including benzodiazepines, oral antipsychotics and biperiden. We included a total of 116 patients diagnosed with BPD and treated with antipsychotic medication: 50 using a LAI antipsychotic formulation and 66 using the equivalent main oral antipsychotic. Patients treated with LAIs showed a decreased ratio of visits to emergency compared with the oral treatment group, and between LAIs, PP3M vs. aripiprazole-1-month group. Furthermore, patients treated with LAIs used lower number and dose of concomitant antipsychotics compared with patients treated with oral antipsychotics. Moreover, PP1M and PP3M used lower daily dose of diazepam equivalents compared with the aripiprazole-1-month and RLAI treatment groups. In conclusion, the use of LAIs may play a role in the management of BPD. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.