1. ANDREA LD ANti-psychotic Drug REduction in primary care for Adults with Learning Disabilities (ANDREA-LD): A Randomised Double-blind Placebo Controlled Trial

2. The Key points Funded by the Health Technology Assessment Programme Aims to investigate the impact of antipsychotic drug withdrawal in people with a learning disability Aims to inform on risk of behaviour disturbance so as to aid in reducing the personal and societal burden of antipsychotic use in those without psychosis

3. What will ANDREA LD do? Identify people Identify people with a learning disability on antipsychotics without psychosis Apply the intervention Randomise and either withdraw over 6 months or stay on same drug-but blinded Communicate findings High quality evidence to support practice

4. Participants and process Adults with learning disabilities (LD) identified through practice LD registers prescribed one of two anti-psychotic drugs, haloperidol or risperidone, for treatment of challenging behaviour with no known current psychosis or previous recurrence of psychosis following prior drug reduction A 2 arm randomised double-blind placebo-controlled non- inferiority withdrawal trial. Treatment will be primary care led and will be supported by a specially designed trial specific treatment and safety package. During the trial, those in the intervention arm will proceed through 4 monthly approximately 25% reduction stages within a 6 month period (although blinded, the GP has discretion to delay progression to the next step)

5. Why should we do this? The age-specific rate of registered learning disability in people 16 years and over in Wales is 0.47% and adult users of learning disability services in England are also estimated to constitute 0.47% of the adult population; making about 200,000 adults in the two countries combined. An audit of adults with learning disabilities in primary care in Wales (n=9,947) found that 29% were prescribed anti- psychotic medication. An earlier and smaller primary care trial in England found that 21% of 357 adults with learning disabilities were prescribed anti-psychotic medication. Applying the average of the two estimates to the number of people above suggests that there are 50,000 adults with learning disabilities in England and Wales who are prescribed anti-psychotic drugs.

6. Who is doing this?

7. Why should we do this? The rate of prescription of anti-psychotic medication in this population far exceeds the estimated prevalence of psychosis (3-4%). The discrepancy may be accounted for by the use of anti-psychotic medications for the treatment of behavioural problems, the commonest reason for their prescription The effectiveness of anti-psychotic medications in treating or controlling challenging behaviour has not been demonstrated

8. The small print……

9. A call for support from LDAN Please support recruitment Please spread the word that this is a unique opportunity to address the science needed to impact on one of the largest negative impacts on the health of people with a learning disability THANK YOU