OBJECTIVE: To compare time to first psychiatric-related hospitalization and time to first medication switch in schizophrenia patients receiving risperidone long-acting injectable (RLAI) or a new oral atypical antipsychotic. METHODS: Study sites participating in RLAI clinical trials in Canada carried out a retrospective chart review of hospitalization and medication use in schizophrenia patients initiated on RLAI between June 1, 1999 and November 30, 2000. Identical parameters were assessed in similar patients initiated on a new oral atypical antipsychotic (control patients) over the same period. RESULTS: Sixty-three RLAI and 74 control charts were reviewed. Control patients were significantly younger than those in the RLAI group (39.1 years versus 45.3, p=0.0073) and received risperidone (48.6%), olanzapine (41.9%) and quetiapine (6.8%) as the oral atypical antipsychotic. Over the assessment periods, 56.8% of control patients were hospitalized versus 4.8% of RLAI patients (p<0.0001). For those patients hospitalized, time to first hospitalization was marginally but not significantly lower for RLAI patients at 13.8 months compared to 19.3 months for the control patients, respectively (p=0.6365). However, control patients had a significantly increased risk of hospitalization, as indicated by Kaplan Meier survival analysis (p<0.0001 by log-rank test). There was no significant difference in the number of patients switching medication (47.6% and 59.5% for RLAI and controls respectively, p=0.1742) or in time to first medication switch (39.71 and 34.52 months, log-rank p=0.2076). However, time to relapse, defined as a hospitalization or a medication switch, was significantly different (p=0.0004 by log-rank test) with 50% of controls reaching this endpoint at 18 months versus 60 months for RLAI patients. CONCLUSIONS: This study provides evidence that RLAI is superior to oral atypicals in reducing hospitalizations. Furthermore, by virtue of its bi-weekly administration, RLAI offers atypical therapy without the serious compliance issues associated with an oral medication, providing clinical and potential economic advantages.