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Corbeil O, Essiambre AM, Béchard L, Roy AA, Huot-Lavoie M, Brodeur S, Chandrasena R, Thériault C, Crocker C, Melun JP, Tibbo P, Demers MF, Roy MA. Real-life effectiveness of transitioning from paliperidone palmitate 1-monthly to paliperidone palmitate 3-monthly long-acting injectable formulation. Ther Adv Psychopharmacol 2022; 12:20451253221136021. [PMID: 36405400 PMCID: PMC9666838 DOI: 10.1177/20451253221136021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-adherence to antipsychotics in schizophrenia is associated with an increased risk of psychotic relapse and hospitalization, a risk that is reduced with the use of long-acting injectable (LAI) antipsychotics. Randomized clinical trials (RCTs) have demonstrated the efficacy of paliperidone palmitate 3-monthly (PP3M) for psychotic relapse prevention in schizophrenia, but it remains poorly documented among individuals treated in real-life settings who can benefit the most out of LAIs. OBJECTIVES The objective of this study was to evaluate the effectiveness of PP3M in relapse prevention among patients with schizophrenia. METHODS This is a multicentre retrospective study conducted in four outpatients' clinics across Canada. All consecutive patients with a main diagnosis of schizophrenia who initiated PP3M between June 2016 and March 2020 were included. The primary outcome was psychotic relapse, defined using broad and clinically relevant criteria. RESULTS Among 178 consecutive patients who were switched to PP3M, the 12-month relapse rate was 18.5% and the relapse-free survival probability was 0.788 (95% confidence interval [CI] = 0.725-0.856). Comorbid diagnoses of personality disorders and substance use disorders were associated with hazard rates (HRs) of 3.6 (95% CI = 1.8-7.3, p < 0.001) and 3.1 (95% CI = 1.6-6.2), respectively. Increased psychopathology severity was associated with an increased likelihood of relapse, while having a job or being in school was protective. CONCLUSION These findings reinforce the necessity of conducting research in patients with comorbid psychiatric disorders who are typically underrepresented in RCTs, yet overrepresented in real-life settings, in order to better inform and guide clinical practice.
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Affiliation(s)
- Olivier Corbeil
- Faculty of Pharmacy, Université Laval, 1050 Av. de la Médecine, Quebec City, QC G1V 0A6, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Anne-Marie Essiambre
- CERVO Brain Research Centre, Quebec City, QC, Canada.,School of Psychology, Université Laval, Quebec City, QC, Canada
| | - Laurent Béchard
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Audrey-Anne Roy
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime Huot-Lavoie
- CERVO Brain Research Centre, Quebec City, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Sébastien Brodeur
- Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada.,Department of Psychiatry, Université Laval, Quebec City, QC, Canada
| | | | | | - Candice Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Phil Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Marc-André Roy
- Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada.,Department of Psychiatry, Université Laval, Quebec City, QC, Canada
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Marques-Teixeira J, Amorim G, Pires AC. Results from PSIPROSPER: A multicenter retrospective study to analyze the impact of treatment with paliperidone palmitate 1-month on clinical outcomes and hospital resource utilization in adult patients with schizophrenia in Portugal. Front Psychiatry 2022; 13:992256. [PMID: 36386977 PMCID: PMC9663469 DOI: 10.3389/fpsyt.2022.992256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic psychiatric disorder with a significant impact worldwide. The early onset and its relapsing nature pose a significant challenge to patients and caregivers. The PSIPROSPER study aimed to characterize the real-world context of schizophrenia treatment in Portugal and to measure the impact of including paliperidone palmitate 1-month formulation (PP1M) in the clinical outcomes (relapses and hospitalizations) and healthcare resource utilization, in a context in which payment scheme in Portugal allows for patients to receive free antipsychotics if prescribed at public hospitals. METHODS This was a multicenter, retrospective, observational study. Male and female adults with a diagnosis of schizophrenia who initiated treatment with PP1M after a minimum of 12 months on an Oral Antipsychotic (OAP), and with complete medical charts, were consecutively included. A mirror-image design over 24 months allowed the comparison of outcomes before and after the PP1M introduction. RESULTS Out of the 51 patients included, 80.4% were male, with a mean age of 34 (±9.8) years. Around 92% of patients were being treated with PP1M at inclusion. Lack of adherence to previous OAP was the main driver for PP1M initiation. Only 9.8% of patients were hospitalized during the PP1M period vs. 64.7% during the OAP period (p < 0.0001). The mean number of hospitalizations (0.1) was significantly lower during the PP1M period (p < 0.0001). Type of treatment was the only variable found to be significant in predicting a lower hospitalization rate and a lower risk of hospitalization. Relapses were significantly lower (p < 0.0001) in PP1M (21.6%) vs. OAP (83.7%). Similarly, the mean change in the number of relapses (p < 0.0001) showed significantly better outcomes in PP1M. CONCLUSION This study supports PP1M as part of schizophrenia treatment in Portugal. Given the lower number of relapses and hospitalizations observed in schizophrenia patients treated with PP1M when compared to OAP-treated patients, this real-world study seems to provide further evidence to support the use of PP1M to treat this condition, in line with previous research. In the context of scarce public resources, these benefits should be carefully considered by healthcare decision-makers to ensure optimal value-based treatment strategies.
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Fernández-Miranda JJ, Díaz-Fernández S, De Berardis D, López-Muñoz F. Paliperidone Palmitate Every Three Months (PP3M) 2-Year Treatment Compliance, Effectiveness and Satisfaction Compared with Paliperidone Palmitate-Monthly (PP1M) in People with Severe Schizophrenia. J Clin Med 2021; 10:1408. [PMID: 33915786 PMCID: PMC8036785 DOI: 10.3390/jcm10071408] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
Paliperidone palmitate every three months (PP3M) is expected to facilitate patient's treatment compliance and satisfaction. The objective here was to compare PP3M treatment compliance and satisfaction, effectiveness and tolerability, with paliperidone palmitate-monthly (PP1M) in patients with severe schizophrenia. A 24-month prospective, open-label study of patients with severe schizophrenia treated with PP3M after at least 2 years of stabilization with PP1M (n = 84) was carried out. Treatment satisfaction was assessed with the Treatment Satisfaction Questionnaire for Medication (TSQM) and with a Visual Analogue Scale (VAS). Effectiveness was measured with psychiatric hospital admissions and the Clinical Global Impression-Severity (CGI-S) scale. Tolerability assessments included laboratory tests, weight and adverse effects. Reasons for treatment discontinuation were recorded. CGI-S significantly improved after 24 months. Three patients changed back to PP1M due to adverse effects, and four were hospitalized. There were neither abandoning nor significant changes in weight or biological parameters, and lower incidence of side effects, with PP3M treatment. TSQM and VAS scales increased. No differences were found related to doses. Apart from somewhat improvement in treatment adherence, effectiveness, and tolerability, patients with severe schizophrenia lengthy treated with PP1M showed more satisfaction with PP3M, even those who needed high doses to get clinical stabilization.
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Affiliation(s)
- Juan J. Fernández-Miranda
- Asturian Mental Health Service Área V-Servicio de Salud del Principado de Asturias (SESPA), 33211 Gijón, Spain; (J.J.F.-M.); (S.D.-F.)
- Asturian Institute on Health Research (ISPA), 33011 Oviedo, Spain
| | - Silvia Díaz-Fernández
- Asturian Mental Health Service Área V-Servicio de Salud del Principado de Asturias (SESPA), 33211 Gijón, Spain; (J.J.F.-M.); (S.D.-F.)
- Asturian Institute on Health Research (ISPA), 33011 Oviedo, Spain
- Faculty of Health Sciences, University Camilo José Cela, 28692 Madrid, Spain;
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, “G. Mazzini” Hospital, ASL 4, 64100 Teramo, Italy
| | - Francisco López-Muñoz
- Faculty of Health Sciences, University Camilo José Cela, 28692 Madrid, Spain;
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
- Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, 4200-072 Porto, Portugal
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, 28029 Madrid, Spain
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