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Cirnigliaro G, Battini V, Castiglioni M, Renne M, Mosini G, Cheli S, Carnovale C, Dell'Osso B. Evaluating the 6-month formulation of paliperidone palmitate: a twice-yearly injectable treatment for schizophrenia in adults. Expert Rev Neurother 2024; 24:325-332. [PMID: 38445396 DOI: 10.1080/14737175.2024.2325655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Paliperidone Palmitate is the only antipsychotic that has been developed in three different intramuscular long-acting injectable (LAI) dosing regimen: monthly (PP1M), quarterly (PP3M), and from 2020 also twice-yearly (PP6M). The latter was approved for the maintenance treatment of adults with schizophrenia and clinically stabilized with PP1M or PP3M. AREAS COVERED Data from studies evaluating efficacy in the maintenance treatment of schizophrenia with PP6M are reviewed. Since no post-marketing safety studies are currently available, data from spontaneous reporting system databases, FAERS and Eudravigilance, are analyzed and the reported treatment-emergent adverse events of PP6M are discussed. EXPERT OPINION The efficacy of PP6M is comparable to that of PP3M in terms of relapses prevention in patients with schizophrenia previously stabilized on PP3M or PP1M. Also, the maintenance of clinical efficacy in the long term has been demonstrated. Data from pharmacovigilance analyses, as well as from phase 3 studies, show that PP6M is generally well tolerated, consistently with PP3M safety data. PP6M allows a longer dosing interval than any other LAI antipsychotics, potentially reducing nonadherence and disease relapses. In future, an increase in the prescription rates of PP6M is expected and real-world efficacy and tolerability studies will be conducted.
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Affiliation(s)
- Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Vera Battini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Castiglioni
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Marica Renne
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giulia Mosini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Stefania Cheli
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Carla Carnovale
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
- CRC "Aldo Ravelli" for Neurotechnology & Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, Università degli Studi di Milano, Milan, Italy
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Boyer L, Falissard B, Nuss P, Collin C, Duret S, Rabbani M, De Chefdebien I, Tonelli I, Llorca PM, Fond G. Real-world effectiveness of long-acting injectable antipsychotic treatments in a nationwide cohort of 12,373 patients with schizophrenia-spectrum disorders. Mol Psychiatry 2023; 28:3709-3716. [PMID: 37479781 PMCID: PMC10730399 DOI: 10.1038/s41380-023-02175-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
This mirror-image study aimed to evaluate the real-life effectiveness of long-acting injectable antipsychotics (LAI) in schizophrenia. Patients with schizophrenia initiating LAIs January 2015-December 2016 were enrolled from the French National Health Data System (SNDS). Standardized mean differences (SMD > 0.1 deemed clinically significant) were calculated for psychiatric healthcare resource utilization measures assessed one year before (during oral AP treatment) and one year after LAI initiation. LAI effectiveness was analyzed overall and by age group, gender and compliance to oral AP, defined as exposure to an AP for at least 80% of the year before LAI initiation. 12,373 patients were included. LAIs were more frequently initiated in men (58.1%), young (18-34 years, 42.0%) and non-compliant (63.7%) patients. LAI initiation was effective in reducing the number and duration of psychiatric hospitalizations and psychiatric emergency department (ED) admissions in non-compliant patients (SMD = -0.19, -0.26 and -0.12, respectively), but not in compliant patients. First-generation LAIs, paliperidone and aripiprazole LAIs reduced psychiatric hospitalizations (SMD = -0.20, -0.24, -0.21, respectively) and ED admissions (SMD = -0.15, -0.13, -0.15, respectively). No differences in effectiveness were found for age or gender. In compliant patients, only aripiprazole LAI reduced the number of psychiatric hospitalizations (SMD = -0.13). Risperidone and paliperidone LAIs increased hospitalization duration (SMD = 0.15 and 0.18, respectively). The prescription of LAIs (except risperidone) should be recommended in all non-compliant patients, even in women and patients aged 35 or older. The lower frequency of administration of LAIs than of oral APs may improve compliance and hence reduce the risk of relapse. Aripiprazole LAI may represent a treatment of choice for compliant patients that should be further investigated.
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Affiliation(s)
- Laurent Boyer
- Centre for Studies and Research on Health Services and Quality of Life (CEReSS), Aix-Marseille University, Marseille, France
| | - Bruno Falissard
- Universite Paris-Saclay, UVSQ, Inserm, Developmental Psychiatry, CESP, Villejuif, France
| | - Philippe Nuss
- AP-HP, Service de Psychiatrie et de Psychologie Médicale, Paris, France
| | | | | | | | | | | | | | - Guillaume Fond
- Centre for Studies and Research on Health Services and Quality of Life (CEReSS), Aix-Marseille University, Marseille, France.
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McKee KA, Crocker CE, Dikaios K, Otter N, Bardell A, Roy MA, Abdel-Baki A, Palaniyappan L, Malla A, Tibbo PG. Short communication: Prevalence of long-acting injectable antipsychotic use in Canadian early intervention services for psychosis. J Psychiatr Res 2023; 165:77-82. [PMID: 37480668 DOI: 10.1016/j.jpsychires.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
The use of long-acting injectable (LAI) antipsychotic drugs for psychotic disorders in Canada has been historically low compared to other jurisdictions despite advantages of LAIs in improving medication adherence and preventing relapse. In response, treatment recommendations were developed in 2013 by the Canadian Consortium for Early Intervention in Psychosis and other Canadian provincial expert groups. The impact of these guidelines needed to be assessed. To document practices in LAI use in early intervention services (EIS) for psychosis, Canadian EIS were surveyed in 2016 (n = 18) and 2020 (n = 12). Trends and descriptive information were examined using repeated cross-sectional survey data. Eight EIS responded to surveys at both time points allowing for longitudinal comparisons. Outcomes of interest included i) LAI use frequency, ii) timing of LAI starts, and iii) factors influencing LAI use. Cross-sectional analysis identified a significant increase in overall LAI usage (24.7% in 2016; 35.1% in 2020). Longitudinal analysis indicated that patients in the second program year saw the greatest increase in LAI use between 2016 and 2020 (25.6% vs. 36.1%), especially among patients under community treatment orders (65.5% vs. 81.5%). Results support increases in LAI use over time, accessibility, awareness, and increasing comfortability among Canadian clinicians.
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Affiliation(s)
- Kyle A McKee
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katerina Dikaios
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicola Otter
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada
| | - Andrea Bardell
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, University of British Columbia, Victoria, British Columbia, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc-André Roy
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Département de Psychiatrie et Neurosciences, Faculté de Médecine de L'Université Laval, Québec, Canada; Clinique Notre-Dame des Victoires, Centre Intégré Universitaire de La Capitale Nationale, Québec, Canada
| | - Amal Abdel-Baki
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, University of Montreal, Québec, Canada; Department of Psychiatry, Centre Hospitalier de L'Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de L'Université de Montréal, Canada
| | - Lena Palaniyappan
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada.
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Groenendaal E, Lynch S, Dornbush R, Klepacz L, Ferrando S. Clinical determinants, patterns and outcomes of antipsychotic medication prescribing in the treatment of schizophrenia and schizoaffective disorder: A naturalistic cohort study. J Psychiatr Res 2023; 158:273-280. [PMID: 36623361 DOI: 10.1016/j.jpsychires.2022.12.044] [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: 06/11/2022] [Revised: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Schizophrenia affects individuals, families, and systems, with treatment primarily being antipsychotic medications. Long-acting injectable (LAI) antipsychotics are increasingly being used. This study sought to identify predictors of antipsychotic choice, in terms of formulation (LAI vs oral) and class (FGA vs SGA), and clinical outcomes. METHODS 123 patients who received LAI antipsychotics were diagnosis-matched to patients who received oral antipsychotics. Sociodemographic and clinical factors were extracted from the medical record, including indicators of illness severity. Groups were compared with Chi-Square and t-tests, and logistic regression models were used to identify independent predictors of antipsychotic choice. RESULTS Patients that received LAIs had longer admissions, more complex discharges, and greater illness severity; however, there were no differences in readmission rates. Independent predictors of LAIs included younger age, being single, and longer admission. Patients who received FGA LAIs were more likely to use substances and be undomiciled compared to SGA LAIs, with the only predictor being older age. Oral FGAs were more likely than Oral SGAs to be prescribed to older and female patients, as well as those with co-occurring substance use, complex discharges, and longer admissions. CONCLUSIONS Illness severity and duration of illness appear to drive choice of LAI vs. oral antipsychotic medication and FGA vs. SGA. While LAIs were prescribed to patients with greater illness severity, readmission rates were equivalent to those receiving oral medication, supporting the use of LAI in patients with greater illness severity. Rationales for prescribing LAIs to younger patients and FGAs to older patients are discussed.
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Affiliation(s)
| | - Sean Lynch
- New York Medical College, USA; Mount Sinai Beth Israel, USA
| | - Rhea Dornbush
- New York Medical College, USA; Westchester Medical Center, USA
| | - Lidia Klepacz
- New York Medical College, USA; Westchester Medical Center, USA
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Martins PS, Caldas F, Oliveira C, Mota J, Gonçalves M. A 10-year mirror-image study of effectiveness and cost of long-acting paliperidone palmitate injectable in patients with schizophrenia or schizoaffective disorder. Psychiatry Res 2022; 312:114581. [PMID: 35509132 DOI: 10.1016/j.psychres.2022.114581] [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: 02/27/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Acute episodes of Schizophrenia and Schizoaffective Disorder often require hospitalizations and/or psychiatry emergency room (PER) visits, with significant economic burden. Long-acting injectables (LAI), such as the once-monthly Palmitate Paliperidone LAI (1MPP) are effective in suppressing symptoms and raise treatment adherence. This study is the first aimed at evaluating long-term efficacy of initiation of 1MPP. This was a mirror-image study with a total 10 year observational length. Sample was divided into five different groups according to time span of observation: 2,4,6,8, and 10 years. Number of participants per group was 162, 129, 95, 77 and 35, respectively. Main outcomes were number and length of hospitalizations and number of PER visit. Significant reductions in these outcomes after initiation of 1MPP were found in all groups. Subgroups consisting only of patients with full adherence were evaluated, and these had better outcomes. A cost evaluation was also performed, which demonstrated decreases every year, for all main outcomes. Sensitivity analysis in the 2-year group showed results in this time-frame are independent of gender, diagnosis, previous LAI or 1MPP initiation setting. Initiation of 1MPP reduces number and length of hospitalizations up to 5 years, decreasing associated costs. This study increases evidence supporting use of 1MPP in patients with Schizophrenia or Schizoaffective disorder.
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Affiliation(s)
| | | | | | - Jorge Mota
- Hospital de Magalhães Lemos. Porto, Portugal
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Peitl V, Margetić BA, Vidrih B, Karlović D. The Impact of Long-acting Paliperidone in Reducing Hospitalizations and Clinical Severity in Recent Onset Schizophrenia: A Mirror-image Study in Real-world Clinical Setting. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:118-125. [PMID: 35078954 PMCID: PMC8813319 DOI: 10.9758/cpn.2022.20.1.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
Objective Schizophrenia is a debilitating disease that disrupts the lives of many affected individuals and exerts a toll on the health system. Only few studies assessed once-monthly injectable formulation of paliperidone palmitate (PP-1M) and other long-acting antipsychotics in recent onset schizophrenia (ROS). To evaluate whether PP-1M is efficacious in reducing frequency and length of hospitalizations and psychosis symptom severity in patients with ROS. Methods This mirror-image study included 112 patients, suffering from ROS admitted in a psychiatric ward and successively treated with PP-1M for 1-year. Other psychotic disorders were excluded. We collected socio-demographic data of all subjects included, number and days of hospitalization, as well as Clinical Global Impression-Severity scale (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation and after 1-year of PP treatment. Results After 1-year PP-1M treatment, mean scores of both CGI and CRDPSS significantly decreased (p < 0.001), as well as the mean number of hospitalizations (p = 0.002) and total hospitalization days (p < 0.001) in comparison with those of the previous year. Conclusion Our results suggest that PP-1M can be considered as an important therapeutic option in patients with ROS. Its use led to a meaningful reduction in the patient’s use of hospital services, as well as a significant clinical improvement of psychotic symptoms in our sample.
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Affiliation(s)
- Vjekoslav Peitl
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- Catholic University of Croatia, Zagreb, Croatia
| | - Branka Aukst Margetić
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- Catholic University of Croatia, Zagreb, Croatia
| | - Branka Vidrih
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- Catholic University of Croatia, Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- Catholic University of Croatia, Zagreb, Croatia
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Multiple sclerosis by phenotype in Germany. Mult Scler Relat Disord 2022; 57:103326. [PMID: 35158442 DOI: 10.1016/j.msard.2021.103326] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND A diagnosis of multiple sclerosis (MS) can be categorized based on its disease course into the following phenotypes: relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS). With one exception, studies of MS by phenotype either provide only prevalence data or if describing drug utilization, the emphasis is on patients with RRMS; while drug utilization by phenotype tends to be examined over the course of a year. No recent studies have comprehensively evaluated MS phenotypes by prevalence, drug utilization, and comorbidities over time from a population-based perspective, which is essential for understanding the disease burden and identifying unmet needs in MS. Germany is one of the few countries where specific MS phenotypes are commonly recorded in routine clinical practice. The purpose of this study was to compare MS phenotypes with respect to changes in their population-based prevalence rates and the types of MS treatments prescribed over time, as well as the frequency of clinical conditions associated with MS based on data from a German health insurance database. METHODS This retrospective, observational, cohort study used data from a German health insurance database for the period 2010 to 2017. Patients aged 18+ years with a specified phenotype of MS based on ICD-10 diagnosis coding were included in the analysis. RESULTS In 2010, RRMS was reported in 73%, PPMS in 8%, and SPMS in 19% of patients with MS with a known phenotype. The mean ages of patients were 41.4, 53.6, and 52.8 years, respectively, and all phenotypes were associated with a female predominance (69%, 63% and 63%, respectively). The prevalence rate of each phenotype markedly increased during the study period (RRMS +113%, PPMS +40%, SPMS +54%; in 2017 the rates were 183, 14, and 34 per 100,000, respectively). The mean age of patients reporting each phenotype also increased (p<0.01), while the female:male proportion remained stable in RRMS and SPMS, the proportion of females significantly declined over time in the PPMS group. The overall percentage of patients prescribed a disease-modifying drug increased across the phenotypes from 51% to 57%. Prescription of interferon-based therapies declined in each phenotype, with the greatest declines observed in RRMS and PPMS. The PPMS and SPMS groups had significantly more prescriptions for symptom management than the RRMS group. Depression was the most prevalent clinical condition associated with each phenotype. There was a significant difference in the percentage of patients with depression across the phenotypes (p = 0.03), with the highest among SPMS (44%) compared with RRMS (35%) or PPMS (37%). Significant differences (p<0.05) across the phenotypes were also observed for the composite prevalence of cardiovascular conditions (highest in PPMS) and cognitive dysfunction (highest in SPMS). CONCLUSION The increasing numbers of patients across each MS phenotype, aging population in patients with MS regardless of phenotype, gender differences and variations across the types of treatments prescribed, and clinical conditions associated with each MS phenotype present new insight into the disease burden and treatment strategies of MS. These should be considered when developing healthcare strategies and optimizing care for patients with MS.
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Di Lorenzo R, Iorio A, Pinelli M, Magarini F, Marchi M, Sacchetti A, Calogero C, Galeazzi GM, Ferri P, Rovesti S, Minarini A. Effectiveness and Quality of Life with Paliperidone Palmitate 3-Monthly in Comparison with Other Long-Acting Drugs. Neuropsychiatr Dis Treat 2022; 18:829-846. [PMID: 35440870 PMCID: PMC9013412 DOI: 10.2147/ndt.s356341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Antipsychotic long-acting injections (AP-LAIs) are indicated for patients affected by schizophrenia especially those with poor treatment adherence. PATIENTS AND METHODS To compare paliperidone palmitate 3-monthly (PP3M), paliperidone palmitate one-monthly (PP1M) and haloperidol decanoate (HAL-D) treatment, we enrolled 90 patients with schizophrenia treated in Mental Health Center with one of the three AP-LAIs for at least six months and followed them for another 6 months. At 6 and 12 months of treatment we administered Clinical Global Impression-Severity, Global Assessment of Functioning and World Health Organization Quality of Life-26 items (WHOQOL-BREF). At 1-year treatment, we evaluated relapses (psychiatric hospitalizations and urgent consultations), side effects and drop-outs. RESULTS We did not highlight any statistically significant difference among the three treatments in relapses and scale scores. Weight increase was significantly higher in PP1M and PP3M groups. Twelve patients (13.3%) discontinued AP-LAI. At 1-year AP-LAI treatment, 69% of patients rated quality of life as "good" or "very good" and 71% declared themselves to be "satisfied" or "very satisfied". CONCLUSION HAL-D, PP1M and PP3M 1-year treatments were similarly effective in preventing relapses and improving quality of life and health satisfaction. All discontinuations in the new 3-monthly antipsychotic treatment were caused by patient refusal to continue it.
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Affiliation(s)
- Rosaria Di Lorenzo
- Service of Psychiatric Diagnosis and Care, Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy
| | - Anita Iorio
- Psychiatric Rehabilitation Technique Programme, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Pinelli
- School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Magarini
- School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Sacchetti
- School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Calogero
- Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Minarini
- Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, MO, Italy
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Takács P, Kunovszki P, Timtschenko V, Fehér L, Balázs T, Hegyi R, Czobor P, Bitter I. Comparative Effectiveness of Second Generation Long-acting Injectable Antipsychotics Based on Nationwide Database Research in Hungary: An Update. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac013. [PMID: 39144770 PMCID: PMC11205877 DOI: 10.1093/schizbullopen/sgac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Greater 1-year and 2-year treatment continuation rates and longer median time to discontinuation for second-generation antipsychotic (SGA) long-acting injectables (LAIs) vs oral antipsychotics (OAPs) in Hungary were previously reported. This study reports an updated comparison between new LAIs vs OAPs in Hungary. De-identified claims data from Hungarian National Health Insurance Fund database of schizophrenia patients who were newly initiated on SGAs (November 01, 2016 to June 30, 2017) were retrospectively analyzed. Primary outcomes were likelihood of all-cause 1-year and 1.5-year discontinuation of newly initiated SGA and median time till discontinuation. Among 5400 patients, 3977 (73.6%) were OAP users and 1423 (26.4%) were LAI users. The 1-year continuation rate were 12.7% (risperidone)-34.1% (olanzapine) for OAPs and 26.4% (risperidone LAI)-78.6% (paliperidone 3-monthly [PP3M]) for LAIs. The 1.5-year continuation rates were 9.3%-29.5% for OAPs and 24.9%-76.4% for LAIs. Median (95% CI) time to discontinuation was 52 (33-67) days (clozapine)-152 (134-168) days (aripiprazole) for OAPs and 125 (64-196) days (risperidone LAI)-491 (250-not reached) days (aripiprazole LAI) for LAIs. All-cause discontinuation risk was significantly higher in all OAPs vs PP3M and aripiprazole LAI (P < .01) as well as in each LAI vs PP3M (P < .05). Patients switching on new LAIs from another LAI remained longer than those who switched from OAPs/no previous treatment. Results showed the advantage of LAIs over OAPs in terms of time to treatment discontinuation. Moreover, new SGA LAIs (PP3M) seem to be better than previous LAIs in terms of time to treatment discontinuation.
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Affiliation(s)
| | | | - Valeria Timtschenko
- Health Economics, Market Access, & Reimbursement, Janssen Cilag, Neuss, Germany
| | | | | | | | - Pál Czobor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Pae CU, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS. Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not? CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:434-448. [PMID: 34294613 PMCID: PMC8316655 DOI: 10.9758/cpn.2021.19.3.434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Antipsychotic monotherapy (APM) is considered best-acceptable treatment option regardless of antipsychotic class and formulation types for treating schizophrenia. However, antipsychotic polypharmacy (APP) has been also widely utilized in routine clinical practice. Despite APP has some clinical benefits it has also numerous pitfalls in relation with increased total number and doses of APs leading to adverse events as well as decrease of treatment adherence and persistence resulting in poor clinical outcomes. Recent introduction of long-acting injectable antipsychotics (LAIs) to the market has offered a chance for better medication adherence/persistence and also provided a simplification of treatment regime leading to more stabilized treatment for schizophrenia patients. When we cannot stay away from APP in the treatment of schizophrenia, clinicians need to find more proper APP regimens and thereby utilization of APP in efficient way should be a practical strategy to benefit schizophrenia patient in a real world treatment setting. With this regard, LAIs can be one of available APP regimen for treatment of schizophrenia in routine practice since their clinical utility and pharmacokinetic stability over oral APs have been well-elaborated today. However, when we have to commence LAIs as a part of APP with oral APs or other LAIs, every effort should be made before doing so whether or not validated and available treatment options or other clinical factors were not done or evaluated yet. Any treatment guidelines do not support APP regardless of the formulation of APP regimen or address two or more LAIs for treatment of schizophrenia till today.
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Affiliation(s)
- Chi-Un Pae
- Department of Psychiatry
- Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | | | | | - Ashwin A. Patkar
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry 2021; 8:387-404. [PMID: 33862018 DOI: 10.1016/s2215-0366(21)00039-0] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence of comparative benefits of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics for schizophrenia has been inconsistent across study designs. The aim of this study was to evaluate the comparative benefits of LAIs versus oral antipsychotics in three study designs to inform clinical decision making. METHODS We did a comprehensive systematic review and meta-analysis comparing LAIs versus oral antipsychotics for schizophrenia covering three study designs: randomised controlled trials (RCTs), cohort studies, and pre-post studies. Our literature search was without language restrictions, in MEDLINE and PubMed, the Cochrane Library, Scopus, and Embase, for studies published from database inception up to a last search on March 13, 2020. We also searched for unpublished studies and ClinicalTrials.gov. We included studies lasting at least 6 months that targeted adults with schizophrenia and related disorders (>80% of participants). Studies on penfluridol (neither an LAI or daily oral antipsychotic), case reports, and case series with fewer than 20 patients were excluded. Two investigators independently extracted study-level data and resolved disagreement by consensus, or via a third investigator. Study authors were contacted to obtain additional information as needed. For our primary outcome we meta-analysed the risk ratio (RR) for hospitalisation or relapse with LAIs versus oral antipsychotics by a random-effects model, with hospitalisation used preferentially over relapse. As secondary analyses, we reversed the preferential order to relapse over hospitalisation, and assessed hospitalisation risk and relapse risk individually. Other secondary outcomes included all meta-analysable data, classed by relevance to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, and analysed by study design. Dichotomous outcomes were expressed as pooled RR and continuous outcomes as standardised mean difference (SMD). The protocol is registered with PROSPERO (CRD42019142094). FINDINGS We identified 14 687 records, of which 137 studies (397 319 patients) met the inclusion criteria (32 RCTs [23·4%; 8577 patients], 65 cohort studies [47·4%; 377 447 patients], and 40 pre-post studies [29·2%; 11 295 patients]) and were analysed. The quality of studies in terms of risk of bias varied across study designs and within each study design from low to high. LAIs were associated with a lower risk of hospitalisation or relapse than oral antipsychotics in each of the three study designs (RCTs: 29 studies, 7833 patients, RR 0·88 [95% CI 0·79-0·99], p=0·033; cohort studies: 44 studies, 106 136 patients, RR 0·92 [0·88-0·98], p=0·0044; pre-post studies: 28 studies, 17 876 patients, RR 0·44 [0·39-0·51], p<0·0001). This association was maintained across the study designs when we reversed the preferential order to risk of relapse over hospitalisation, and in individual analysis of hospitalisation risk. The association was maintained only in pre-post studies for relapse risk alone. In all other outcomes related to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, LAIs were more beneficial than oral antipsychotics in 60 (18·3%) of 328 comparisons, not different in 252 (76·8%) comparisons, and less beneficial in 16 (4·9%) comparisons when analysed by study design. Significant heterogeneity was observed across all three study designs. Publication biases were apparent in cohort and pre-post studies, but effect sizes were similar after trim-and-fill analyses. INTERPRETATION Although study designs have strengths and weaknesses, including potential low quality of observational studies, we consistently identified significant benefit with LAIs versus oral antipsychotics in preventing hospitalisation or relapse, in settings ranging from restricted research (RCTs) to real-word application (cohort and pre-post studies). Our findings suggest that increased clinical use of LAIs could improve outcomes in schizophrenia. FUNDING None. TRANSLATIONS For the Chinese, French, German, Italian, Japanese, Portugese and Spanish translations of the abstract see Supplementary Materials section.
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Olivares JM, González-Pinto A, Páramo M. Predictors of persistence in patients with schizophrenia treated with aripiprazole once-monthly long-acting injection in the Spanish clinical practice: a retrospective, observational study. Eur Psychiatry 2021; 64:e40. [PMID: 33840396 PMCID: PMC8260564 DOI: 10.1192/j.eurpsy.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Poor adherence to antipsychotic drugs is a major problem in schizophrenia management and one of the most important risk factors for relapse and hospitalization. To date, there is little evidence on persistence predictors with long-acting injectable antipsychotics, especially with aripiprazole once-monthly (AOM). This study (NCT03130478) aimed to describe the impact of demographic and clinical characteristics on persistence with AOM treatment in real-world setting. Methods This was an observational, retrospective, non-interventional study that included adult patients with schizophrenia who were initiated on AOM during a schizophrenia-related hospitalization. Data were retrospectively collected from patients’ medical records. The primary variable was persistence with AOM, measured as the number of days from AOM initiation up to all-cause AOM discontinuation during the first six months after treatment index. Results 140 patients were enrolled and 91 fulfilled the selection criteria. Six months after AOM initiation, 65 (71.4%) patients were still receiving AOM treatment, whereas 26 (28.6%) were not. The mean (standard deviation) time to AOM treatment discontinuation in the first six months was 138.1 (6.8) days, with most of the patients discontinuing at the first 28 days. The risk of AOM discontinuation in the first six months increases 1.05-fold annually since schizophrenia diagnosis (p=0.003); moreover, this risk increases 2.86-fold in patients with concomitant schizophrenia medication at AOM initiation compared to patients without concomitant schizophrenia treatments (p=0.02). Conclusions Main factors predicting persistence with AOM treatment at six months in clinical practice are fewer years since schizophrenia diagnosis and not receiving concomitant schizophrenia treatments at AOM initiation.
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Affiliation(s)
- José Manuel Olivares
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Mario Páramo
- Complejo Hospitalario Universitario de Santiago Compostela, Santiago de Compostela, Spain
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Karlović D, Silić A, Crnković D, Peitl V. Effects of aripiprazole long-acting injectable antipsychotic on hospitalization in recent-onset schizophrenia. Hum Psychopharmacol 2021; 36:e2763. [PMID: 33058260 DOI: 10.1002/hup.2763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. METHODS This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. RESULTS Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p = 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). CONCLUSION Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio-economic healthcare burden.
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Affiliation(s)
- Dalibor Karlović
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia
| | - Ante Silić
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia
| | - Danijel Crnković
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Vjekoslav Peitl
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia
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Time to Treatment Discontinuation in German Patients with Schizophrenia: Long-Acting Injectables versus Oral Antipsychotics. Clin Drug Investig 2020; 41:99-113. [PMID: 33331979 PMCID: PMC7815621 DOI: 10.1007/s40261-020-00990-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/03/2022]
Abstract
Background and Objective Long-acting injectable antipsychotics (LAIs) are associated with better treatment adherence and persistence than oral antipsychotics (OAPs) in patients with schizophrenia. However, real-world evidence assessing the impact of treatment with LAIs in Germany is limited. To fill this gap, we compared antipsychotic medication adherence and risk of treatment discontinuation (TD) among schizophrenia patients newly initiated on LAI or who switched their OAP regimen (overall cohort; OC). Methods Claims data of German schizophrenia patients who initiated LAIs or switched their OAP during 2012–2016 (index date) were retrospectively analyzed. Treatment switch was defined as add-on medication to existing prescription or terminating the existing prescription and initiating another OAP. Adherence and time to treatment discontinuation (TTD) were estimated. Determinants of treatment discontinuation were analyzed using two Cox regression models. Model 1 controlled for age, sex, and Charlson Comorbidity Index (CCI); model 2 also included insurance status, and medication, visit, and psychiatric inpatient stay costs. Sensitivity analysis on patients who terminated existing prescriptions and initiated new OAPs (complete switch cohort; CSC) was performed. Results In OC (n = 2650), LAI users had better adherence (35.4% vs. 11.6%), persistence (no 60-day gap; 40.7% vs. 19.8%), and longer TTD (median [95% confidence interval (CI)] 216 [193–249] vs. 50 [46–56] days) than OAP users. OAP usage (hazard ratio [HR] 1.89, 95% CI 1.73–2.06; p < 0.001) and greater CCI (HR 1.04, 95% CI 1.00–1.07; p = 0.023) were associated with greater risk of TD in model 1. Model 2 showed similar results. LAI users in CSC also had better adherence, persistence, and longer TTD. In CSC too, OAP usage and greater CCI were associated with greater risk of TD in model 1, but only CCI was significant in model 2. Higher pre-index psychiatric inpatient costs were associated with lower risk of TD (HR 0.99, 95% CI 0.98–1.00; p = 0.014). Limitations Inherent limitations of claims data and lack of control on OAP administration may have influenced the results. Conclusion This real-world study associates LAIs with better medication adherence and lower antipsychotic discontinuation risk than OAPs. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-020-00990-8.
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