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Vgontzas AN, Paschalidou A, Simos PG, Anastasaki M, Zografaki A, Volikos E, Koutra K, Basta M. Impact of long-acting injectable antipsychotics vs. oral medication on relapses of patients with psychosis and bipolar disorder. Psychiatry Res 2024; 332:115676. [PMID: 38176166 DOI: 10.1016/j.psychres.2023.115676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
Relapse associated with multiple hospital readmissions of patients with chronic and severe mental disorders, such as psychosis and bipolar disorder, is frequently associated with non-adherence to treatment. The primary aim of the study was to compare the effectiveness of long-acting injectable (LAI) treatment, vs. oral medication in reducing readmissions of patients with psychotic or bipolar disorder in a community sample of 164 patients with psychosis and 29 patients with bipolar disorder (n = 193), with poor adherence to oral medication. The mean follow up period was 5.6 years and the number of readmissions were compared for an equal-length period of oral treatment preceding the onset of LAI administration. We observed a significant decrease of 45.2 % in total hospital readmissions after receiving LAIs treatment. The effect was significant both for patients with a pre-LAI treatment history of predominantly voluntary hospitalizations and with predominantly involuntary admissions. In addition, we observed equal effectiveness of first- vs. second-generation LAIs in reducing total hospital readmissions regardless of type of pre-treatment admission history (voluntary vs. involuntary). LAIs appear to be effective in reducing both voluntary and involuntary hospital readmissions in patients with psychosis and bipolar disorder with a history of poor adherence to treatment.
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Affiliation(s)
- Alexandros N Vgontzas
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Sleep Research and Treatment Center Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - Anna Paschalidou
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Panagiotis G Simos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece; Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
| | - Maria Anastasaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Avgi Zografaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Emmanouil Volikos
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
| | - Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymnon, Crete 74100, Greece
| | - Maria Basta
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
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Okoli CTC, Kappi A, Wang T, Makowski A, Cooley AT. The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis. Int J Ment Health Nurs 2022; 31:469-535. [PMID: 34931437 DOI: 10.1111/inm.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Long-acting injectable (LAI) antipsychotic medications may be an important modality of reducing costs, improving symptoms, and fostering quality of life outcomes for those with schizophrenia. Our objective was to systematically review and conduct a meta-analysis of the effectiveness of LAIs compared with oral antipsychotics on medication adherence, symptom remission/relapse, rehospitalization, outpatient visits, emergency department visits, healthcare costs, and social functioning. We performed a systematic search of PsycInfo, CINAHL, PubMed, and Scopus databases to examine studies meeting inclusion criteria prior to August 30th, 2020. Randomized controlled trials, retrospective studies, prospective studies among people with schizophrenia with at least 6-month follow-up data were obtained. Overall effect sizes and associated 95% confidence intervals (CI) were estimated with random-effects modeling. We found 75 articles meeting our inclusion criteria, including 341 730 individuals with schizophrenia. Systematic review results indicated that LAIs compared with orals improved medication adherence (25/29 studies), symptom remission/relapse (10/18 studies), rehospitalizations (26/49 studies), emergency department visits (9/17 studies), medical costs (11/15 studies), and social functioning (5/9 studies); however, LAIs also increased outpatient visits (7/16 studies) and pharmacy costs (10/10 studies). Meta-analytic results of studies with similar outcome measures did not find differences between LAIs and orals in respect to outcomes, except lowering emergency department visits and increasing pharmacy costs. The differences between the results of the narrative synthesis and the meta-analyses were possibly because of the low availability of studies with similar outcomes in the pooled analyses. Our overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia. These findings support clinical practice in encouraging providers to prescribe LAIs when indicated.
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Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Tianyi Wang
- Department of Statistics, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Andrew Makowski
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Andrew T Cooley
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Pippal N, Halder S, Srivastava S, Kar R, Gupta R, Anthonio AE. Correlation between telomere length and efficacy of oral and long-acting injectable antipsychotics on severity and cognitive impairment of schizophrenia. Int J Psychiatry Clin Pract 2022; 26:157-164. [PMID: 34715000 DOI: 10.1080/13651501.2021.1994613] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the correlation between telomere length (TL) and long-acting injectable (LAI) and oral atypical antipsychotic (OAA) efficacy on schizophrenia (SCZ) severity and cognitive impairment. METHODS Sixty Schizophrenia patients of 18-50 years and of either sex were included in a 12-week study. Thirty patients were recruited in each group, LAI and OAA. Positive and Negative Syndrome Scale (PANSS) and National Institute of Mental Health and Neuro-Sciences (NIMHANS) neuropsychological battery tests were evaluated at baseline and 12 weeks. TL was estimated at baseline. RESULTS Both groups showed a significant improvement in PANSS and NIMHANS battery test scores after treatment (p < 0.001) within the group, though not between the groups. Mean TL at baseline was 407.58 ± 143.93 and 443.40 ± 178.46 in LAI and OAA groups respectively. A significant negative correlation (r = -0.28, p = 0.03) of TL was seen with the mean change in negative PANSS score after treatment. CONCLUSIONS LAI antipsychotics are similar to OAA in decreasing the disorder severity and improving the cognitive impairment in schizophrenia. Also, patients who have shorter TL show greater improvement in the negative PANSS score. Hence, TL holds the potential of predicting antipsychotic drug response in schizophrenia patients.KEY POINTSLong-acting injectable antipsychotic was comparable to oral atypical antipsychotics in bringing out improvement in disorder severity, cognitive functions over 12 weeks.Shorter telomere length has been found to be associated with a greater response in negative symptoms of schizophrenia.
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Affiliation(s)
- Nisha Pippal
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sumita Halder
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shruti Srivastava
- Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rajarshi Kar
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Almeida Edelbert Anthonio
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Portela R, Wainberg ML, Castel S, de Oliveira HN, Ruas CM. Risk factors associated with readmissions of patients with severe mental disorders under treatment with antipsychotics. BMC Psychiatry 2022; 22:189. [PMID: 35300649 PMCID: PMC8931964 DOI: 10.1186/s12888-022-03794-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission. METHODS Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression. RESULTS Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03-1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63-2.27) when patients did not adhere to maintenance treatment compared to those who adhered. CONCLUSIONS Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.
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Affiliation(s)
- Ronaldo Portela
- Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil.
| | - Milton Leonard Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA
| | - Saulo Castel
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Helian Nunes de Oliveira
- grid.8430.f0000 0001 2181 4888UFMG, Social and Preventive Medicine Department of Medical School, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- grid.8430.f0000 0001 2181 4888Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil
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Gary C, Déal C, Boursicot-Beuzelin J, Falissard B, Giordana JY, Fakra E, Samalin L, Bouju S. Initiation of quarterly palmitate paliperidone in French clinical practice: results from the observational, cross-sectional OPTIMUS study. Pharmacoepidemiol Drug Saf 2021; 31:334-342. [PMID: 34897888 DOI: 10.1002/pds.5397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/02/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE Long-term antipsychotic treatment is key to a positive clinical outcome in schizophrenia. Recent guidelines recommend the prescription of long-acting antipsychotic formulations (LAIs) as early as the first episode in patients with schizophrenia. The OPTIMUS study evaluated real-world use of a new three-monthly paliperidone palmitate formulation (PP3M) in France. METHODS For this observational cross-sectional study, all French psychiatrists were invited to enrol patients who had initiated PP3M in the previous 4 months. Snapshot data were collected at a routine consultation, without any modification of clinical practice. RESULTS This population of 350 patients with schizophrenia started on PP3M predominantly included single men, living independently with a diagnosis of schizophrenia for a median of 9.3 years. Demographic characteristics were broadly comparable to those reported in other studies on LAIs. Investigators cited treatment simplification (96.9%) and patient comfort (93.3%) as the most common reasons for switching to PP3M; enhancing adherence was mentioned less often (61.1%) with most patients previously considered as adherent, and a majority of them expressing a positive attitude to their treatment. One-third of patients accepted the psychiatrist's proposal to initiate PP3M treatment without any discussion, and relatives were involved in the therapeutic decision-making process in only 23.7% of cases. After initiation, few changes were seen in professional follow-up frequency or concomitant pharmacological and non-pharmacological treatment modalities except for a decrease in antipsychotic polytherapy. CONCLUSIONS PP3M is mostly prescribed in adherent patients with fairly stable schizophrenia, and the longer dosing interval does not substantially affect patient care.
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Affiliation(s)
- Charlotte Gary
- Janssen, Medical Affairs Department, Issy-les-Moulineaux, France
| | - Cécile Déal
- Janssen, Medical Affairs Department, Issy-les-Moulineaux, France
| | | | | | - Jean-Yves Giordana
- Association Hospitalière Sainte-Marie - Centre Hospitalier Sainte-Marie, Nice, France
| | - Eric Fakra
- Centre Hospitalier Universitaire de Saint-Étienne, Hôpital de la Charité, Saint-Étienne, France
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Sophie Bouju
- Janssen, Medical Affairs Department, Issy-les-Moulineaux, France
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Correlative Image-Based Release Prediction and 3D Microstructure Characterization for a Long Acting Parenteral Implant. Pharm Res 2021; 38:1915-1929. [PMID: 34851498 DOI: 10.1007/s11095-021-03145-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
Imaging-based characterization of polymeric drug-eluting implants can be challenging due to the microstructural complexity and scale of dispersed drug domains and polymer matrix. The typical evaluation via real-time (and accelerated in vitro experiments not only can be very labor intensive since implants are designed to last for 3 months or longer, but also fails to elucidate the impact of the internal microstructure on the implant release rate. A novel characterization technique, combining multi-scale high resolution three-dimensional imaging, was developed for a mechanistic understanding of the impact of formulation and manufacturing process on the implant microstructure. Artificial intelligence-based image segmentation and imaging analytics convert "visualized" structural properties into numerical models, which can be used to calculate key parameters governing drug transport in the polymer matrix, such as effective permeability. Simulations of drug transport in structures constructed on the basis of image analytics can be used to predict the release rates for the drug-eluting implant without running lengthy experiments. Multi-scale imaging approach and image-based characterization generate a large amount of quantitative structural information that are difficult to obtain experimentally. The direct-imaging based analytics and simulation is a powerful tool and has potential to advance fundamental understanding of drug release mechanism and the development of robust drug-eluting implants.
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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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de Filippis R, De Fazio P, Gaetano R, Steardo L, Cedro C, Bruno A, Zoccali RA, Muscatello MRA. Current and emerging long-acting antipsychotics for the treatment of schizophrenia. Expert Opin Drug Saf 2021; 20:771-790. [PMID: 33775184 DOI: 10.1080/14740338.2021.1910674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: In this review, the authors discuss the role of long-acting injectable antipsychotics (LAIs) for schizophrenia, focusing on the effectiveness and new perspectives introduced by such treatment strategy. Despite their promising pharmacokinetic features and their potential advantages in medication adherence, clinical outcomes, and medical costs, LAIs are not habitually presented as an option for patients, especially in the early phase of schizophrenia.Areas covered: This review explores the panorama of available LAIs for the treatment of schizophrenia, first-episode of psychosis, approved indications, medical costs, medication adherence, side effects, effectiveness and differences between first-generation (FGA)-LAIs and second-generation (SGA)-LAIs.Expert Opinion: LAIs differ in terms of specific indications, approved injection sites, needle size, injection volume, injection interval as well as potential drug-drug interactions, and commonly reported adverse reactions. The approved indications have expanded beyond schizophrenia to include bipolar and schizoaffective disorder. SGA-LAIs are often preferred to FGA-LAIs. FGA-LAIs although are less chosen in new patients due to the induction of cognitive and extrapyramidal side effects, even if, on the other hand, many SGA-LAIs are burden by hyperprolactinemia and weight gain. After a review of the available evidence, insight is provided into the potential and current therapeutic opportunities offered by LAI antipsychotic formulations.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Clemente Cedro
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Antonio Bruno
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Rocco Antonio Zoccali
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Maria Rosaria Anna Muscatello
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Wong MMC, Chung AKK, Yeung TMH, Wong DTW, Lee CK, Lai E, Chan GFY, Mak GKL, Wong JOY, Ng RMK, Mak KY. Guidance on the clinical understanding and use of long-acting injectable antipsychotics in Schizophrenia: Hong Kong Consensus Statements. CNS Neurosci Ther 2021; 27 Suppl 1:5-11. [PMID: 33555614 PMCID: PMC7869935 DOI: 10.1111/cns.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIMS There is increasing evidence showing the importance of long-acting injectable antipsychotics in the management of schizophrenia, especially in terms of improving patient medication compliance. A panel of experienced clinicians in Hong Kong mapped out a set of consensus statements with an aim to facilitate the understanding and use of long-acting injectable antipsychotics among local physicians. METHODS Eight discussion areas regarding long-acting injectable antipsychotics were selected by the chairman of the consensus group. A series of meetings were held for the panelists to discuss the published literature and their clinical experience, followed by the drafting of consensus statements. At the final meeting, each consensus statement was voted on anonymously by all members based on its practicability of recommendation in Hong Kong. RESULTS A total of 12 consensus statements on the rational use of long-acting injectable antipsychotics were established and accepted by the consensus group. CONCLUSION The consensus statements aim to provide practical guidance for Hong Kong physicians on the use of long-acting injectable antipsychotics in schizophrenia patients. These statements may also serve as a reference for doctors in other parts of the Asia-Pacific region.
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Affiliation(s)
| | | | | | | | - Che Kin Lee
- Department of PsychiatryKowloon HospitalKowloonHong Kong
| | - Eric Lai
- Department of Child and Adolescent PsychiatryCastle Peak HospitalTuen MunNew TerritoriesHong Kong
| | | | | | | | | | - Ki Yan Mak
- Private PracticeHong Kong CityHong Kong
- The Mental Health Association of Hong KongPrivate PracticeHong Kong
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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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Mahlich J, Olbrich K, Wilk A, Wimmer A, Wolff-Menzler C. Hospitalization Rates and Therapy Costs of German Schizophrenia Patients Who are Initiated on Long-Acting Injectable Medication: A Mirror-Image Study. Clin Drug Investig 2020; 40:355-375. [PMID: 32152867 PMCID: PMC7105426 DOI: 10.1007/s40261-020-00900-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics can reduce relapse, hospitalization, and costs in patients with schizophrenia. However, real-world evidence assessing the impact of treatment with LAIs in Germany is limited. OBJECTIVE To provide updated evidence on the impact of LAI initiation on hospitalization rates and therapy costs. METHODS Using a mirror-image design, claims data of 850 German patients with schizophrenia who initiated treatment with LAIs during 2013-2015 was retrospectively analyzed. For the included patients, costs and resource utilization were compared for the 12 months before the index date (first initiation of LAI) and the 12 months after the index date. Annual treatment costs, hospitalization rates, ambulatory visits, sick leaves and medical aids were assessed. Two models were used to evaluate hospitalization and its costs. In model 1, hospitalization during the index date (first LAI prescription in 2013-2015) was allocated to the "pre-" time interval, while in model 2 it was neither attributed to the pre- nor to the post-index date. Regression analysis was performed to identify patients who benefited the most in terms of cost reduction from LAI initiation. RESULTS Medication costs were significantly higher post-switching to LAI compared with pre-switching period (€3832 vs €799; p < 0.001). In model 1, number of hospitalizations, days hospitalized, and associated costs were significantly lower post-switching compared with pre-switching (2.3 vs 2.6; 59.2 vs 73.4; and €5355 vs €11,908, respectively; all p < 0.001). Similar results were obtained for costs in model 2 (€5355 vs €10,276; p < 0.001). Mean total costs reduced significantly from pre-switching to post-switching period in model 1 (€13,776 vs €10,418; p < 0.001). Patients with characteristics such as higher number of non-psychiatric and psychiatric inpatient stays during the pre-index period (all p < 0.05) benefited the most from cost reduction after LAI initiation. CONCLUSION In this cohort of German patients with schizophrenia, treatment initiation with LAI resulted in reduced hospitalization rates and total costs.
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Affiliation(s)
- Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany.
- Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| | - Kerstin Olbrich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Adrian Wilk
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | - Antonie Wimmer
- Medical Affairs, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
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12
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Lu L, Ren D, Mullick P, Lee H. Examining patient outcomes of receiving long-acting injectable antipsychotics. Perspect Psychiatr Care 2020; 56:14-19. [PMID: 30746711 DOI: 10.1111/ppc.12364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/27/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this project was to evaluate a long-acting injectable (LAI) antipsychotics program regarding the quality of care and outcomes of individuals with schizophrenia. DESIGN AND METHODS Observational design with retrospective chart review and survey was utilized in an outpatient clinic. FINDINGS Individuals on LAIs receive the quality of care by exhibiting favorable knowledge about LAIs, positive attitude toward medications, and satisfaction with care. They take higher dosages of medications than those who take oral antipsychotics and report decreases in hospitalizations/emergency room visits after LAIs. PRACTICE IMPLICATIONS Reducing reservations about LAIs may provide awareness of the positive effects of treatment leading to viable management options and patient satisfaction.
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Affiliation(s)
- Lin Lu
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Heeyoung Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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13
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Arteaga Duarte CH, Fakra E, Van Gils C, Guillon P. The clinical and economic impact of three-monthly long-acting formulation of paliperidone palmitate versus the one-monthly formulation in the treatment of schizophrenia in France: A cost-utility study. Encephale 2019; 45:459-467. [PMID: 31542210 DOI: 10.1016/j.encep.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Schizophrenia entails a considerable humanistic and economic burden. Improved treatment continuity to antipsychotic therapy is paramount to reduce the risk of relapse. The novel three-monthly paliperidone palmitate treatment (PP3M) offers the longest dosing interval currently available in France. This study assesses its cost-effectiveness, versus the currently available one-monthly long-acting treatment (PP1M) in French schizophrenic patients. METHODS A Markov model with monthly cycles was developed and adapted. It encompassed [a] administration of PP3M or PP1M in first-line, [b] a period where the patient does not receive any active treatment, and [c] a follow-up treatment line consisting of a treatment mix reflecting French clinical practice. Relapse rates in first-line were based on a pivotal non-inferiority head-to-head trial, and treatment discontinuation rates were based on French real-world data. Accounting for differences in drug exposure, time-dependent monthly relapse rates were applied following discontinuation to first line. The impact of a less frequent injection schedule for PP3M in QoL was accounted for through the application of a utility differential. The collective perspective was adopted throughout a 5-year time horizon. Four percent discount rates were applied on costs and outcomes. RESULTS PP3M was dominant when compared to PP1M, featuring an incremental QALY of 0.123 and a cost saving effect (-669€) resulting from reduced therapy costs (drug acquisition, administration and monitoring) and relapse-related costs. Sensitivity analysis supported the robustness of the results. CONCLUSION With slightly better QALY outcomes and a cost-saving effect when compared to PP1M, introducing PP3M is an improvement to the current treatment in France.
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Affiliation(s)
- C H Arteaga Duarte
- IQVIA, Corporate Village, Davos Building, Da Vincilaan 7, 1930 Zaventem, Belgium.
| | - E Fakra
- Department of Psychiatry, University Hospital of Saint-Etienne, TAPE Laboratory, EA7423, Jean Monnet University, 42100 Saint-Étienne, France.
| | - C Van Gils
- IQVIA, Corporate Village, Davos Building, Da Vincilaan 7, 1930 Zaventem, Belgium
| | - P Guillon
- Janssen-Cilag, Rue Camille Desmoulins 1, TSA 91003, 92787 Issy-les-Moulineaux, France
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14
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Arango C, Baeza I, Bernardo M, Cañas F, de Dios C, Díaz-Marsá M, García-Portilla MP, Gutiérrez-Rojas L, Olivares JM, Rico-Villademoros F, Rodríguez-Jiménez R, Sánchez-Morla EM, Segarra R, Crespo-Facorro B. Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rpsmen.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Giordano G, Tomassini L, Cuomo I, Amici E, Perrini F, Callovini G, Carannante A, Kotzalidis GD, De Filippis S. Aripiprazole Long-Acting Injection During First Episode Schizophrenia-An Exploratory Analysis. Front Psychiatry 2019; 10:935. [PMID: 31969843 PMCID: PMC6960223 DOI: 10.3389/fpsyt.2019.00935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Long-acting injectable (LAI) aripiprazole was found to be efficacious in schizophrenia. In common clinical practice, the use of LAIs is often restricted to chronic patients with frequent relapses and poor adherence. Recently, some investigators advanced the idea of early LAI use also in young people with schizophrenia at their first psychotic episode (FEP). Objective: Our study aimed to assess the effect of LAI aripiprazole once monthly (AOM) in the treatment of FEP in patients aged 18-26 years. Methods: We included 50 patients with DSM-5 schizophrenia as assessed with SCID, and used the Clinical Global Impressions Scale-Severity of Illness (CGI-S) and the Positive and Negative Syndrome Scale (PANSS) to assess symptom severity and the World Health Organization Quality of Life (WHOQOL), the Short Form Health Survey (SF-36) and the Personal and Social Performance Scale (PSP) to assess quality of life (QoL) and global health perception at baseline and 3, 6, 9, and 12 months after the first AOM injection. Results: AOM was associated with a progressive improvement, compared to baseline, of both positive (p < 0.001) and negative (p < 0.001) symptoms and in general psychopathology (p < 0.001) and decrease in global severity (p < 0.001). We also observed progressive improvement in QoL and social and personal functioning. Treatment adherence was 78% at study endpoint. Our results support that AOM may improve psychotic symptoms, QoL and social functioning in young FEP patients. Further studies should compare AOM to its oral formulation in the treatment of young patients with schizophrenia at the outset of their illness.
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Affiliation(s)
| | | | - Ilaria Cuomo
- ASL Roma 1, Istituto Penitenziario Regina Coeli, Rome, Italy
| | - Emanuela Amici
- Villa Von Siebenthal Neuropsychiatric Clinic, Rome, Italy
| | - Filippo Perrini
- Istituto A.T. Beck-Diagnostic Centre, Research and Training in Cognitive-Behavioral Psychotherapy, Rome, Italy
| | | | | | - Georgios D Kotzalidis
- Villa Von Siebenthal Neuropsychiatric Clinic, Rome, Italy.,NESMOS Department Neurosciences-Mental Health- and Sensory Organs, School of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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16
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Fefeu M, De Maricourt P, Cachia A, Hoertel N, Vacheron MN, Wehbe E, Rieu C, Olie JP, Krebs MO, Gaillard R, Plaze M. One-year mirror-image study of the impact of olanzapine long-acting injection on healthcare resource utilization and costs in severe schizophrenia. Psychiatry Res 2018; 270:205-210. [PMID: 30267984 DOI: 10.1016/j.psychres.2018.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/27/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022]
Abstract
Olanzapine long-acting injections (OLAIs) are often prescribed to patients with severe schizophrenia who are typically excluded from randomized clinical trials. To date, no mirror-image study has examined the impact of OLAIs on healthcare resource utilizations in these patients. We conducted a retrospective, one-year mirror-image study of OLAIs on 40 patients with severe schizophrenic disorder. Illness severity was defined by failure to respond to two sequential antipsychotics. Outcomes included: (i) healthcare resource utilizations via hospitalization admissions, bed days, outpatient visits, and inpatient service costs computations (ii) clinical efficacy through changes in the Brief Psychiatric Rating Scale (BPRS) and in the Clinical Global Impression-Schizophrenia Scale (CGI-SCH), and (iii) adverse effects. After one year, OLAIs were associated with significant decreases of 65.7%, 86.2% and 86.2% in hospitalization admissions, bed days, and inpatient service costs respectively. A significant mean change of -0.47 and -0.63 was determined the BPRS and the CGI-SCH scores, respectively. There were no significant differences in the number of outpatient visits and adverse effects, except for post-injection sedation/delirium syndrome whose incidence was 0.30% per injection. This mirror-image study provides the first evidence that prescribing OLAIs reduces in a cost-effective manner average bed days and hospital admissions in patients with severe schizophrenia.
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Affiliation(s)
- Mylène Fefeu
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Pierre De Maricourt
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Centre Hospitalier Sainte-Anne, Secteur 15, Paris, France
| | - Arnaud Cachia
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Laboratory for the Psychology of Child Development and Education, CNRS, UMR 8240, Sorbonne, Paris, France & Institut Universitaire de France, Paris, France
| | - Nicolas Hoertel
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, Issy-les-Moulineaux, France
| | | | - Elie Wehbe
- Centre Hospitalier Sainte-Anne, Secteur 13, Paris, France
| | - Christine Rieu
- Centre Hospitalier Sainte-Anne, Pharmacie, Paris, France
| | - Jean-Pierre Olie
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie-Odile Krebs
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marion Plaze
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Park SC, Choi MY, Choi J, Park E, Tchoe HJ, Suh JK, Kim YH, Won SH, Chung YC, Bae KY, Lee SK, Park CM, Lee SH. Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:361-375. [PMID: 30466208 PMCID: PMC6245299 DOI: 10.9758/cpn.2018.16.4.361] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine D2 antagonism-related symptoms.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Haeundae Paik Hospital, Inje University College of Medicine Busan, Korea
| | - Mi Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jina Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Eunjung Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ha Jin Tchoe
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae Kyung Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Young Hoon Kim
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Seung Hee Won
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University Chuncheon Sacred Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Chan Mi Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
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[How to measure real-world effectiveness?]. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:421-435. [PMID: 30103940 DOI: 10.1016/j.pharma.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 01/17/2023]
Abstract
The new use of medico-administrative databases is a major change in the medical assessment field. Given the limits of the randomized clinical trials when it comes to accurately represent the heterogeneity and complexity of medical care in a real-world context, an increasing demand of observational studies comes from healthcare systems as decision tools. The lack of intervention generates real-world data and assesses both the care and the outcomes of patients in routine practice. Despite this external validity, the bias and confounding factors are a challenge to the internal validity of observational studies. An appropriate study design and statistical methods are necessary to neutralize them and consider a causal relationship between a treatment and a clinical outcome.
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19
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Arango C, Baeza I, Bernardo M, Cañas F, de Dios C, Díaz-Marsá M, García-Portilla MP, Gutiérrez-Rojas L, Olivares JM, Rico-Villademoros F, Rodríguez-Jiménez R, Sánchez-Morla EM, Segarra R, Crespo-Facorro B. Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 12:92-105. [PMID: 29954707 DOI: 10.1016/j.rpsm.2018.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 12/18/2022]
Abstract
Antipsychotics are an essential component in the treatment of schizophrenia. Long-acting injectable formulations (LAI) arose to improve adherence with the associated potential of reducing the risk of relapse. The objective of this article is to analyze the use of LAI antipsychotics in Spain, which is similar to other European countries but with a predominance of the use of second generation LAI, to discuss the possible causes of prescribing differences with respect to other countries (including organizational aspects, attitudes of psychiatrists, patients and family members, and clinical practice guidelines), and to discuss their use in acute psychiatric units, first episode, and in children and adolescents. In our view, while it is necessary to increase existing evidence regarding the advantages of LAI antipsychotics and the differentiation between LAI antipsychotics currently available, their use will likely continue to grow driven by clinical experience.
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Affiliation(s)
- Celso Arango
- Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina Universidad Complutense, CIBERSAM, Madrid, España.
| | - Inmaculada Baeza
- Hospital Clinic i Universitari de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), IDIBAPS, Universitat de Barcelona
| | - Miquel Bernardo
- Hospital Clinic i Universitari de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), IDIBAPS, Universitat de Barcelona
| | - Fernando Cañas
- Hospital «Dr. R. Lafora», Universidad Francisco de Vitoria, Madrid, España
| | | | - Marina Díaz-Marsá
- Hospital Clínico de San Carlos, Universidad Complutense, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
| | - María Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, España
| | | | | | | | - Roberto Rodríguez-Jiménez
- Instituto de Investigación Hospital 12 de Octubre (imas12) Madrid, Universidad Complutense de Madrid (UCM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
| | - Eva María Sánchez-Morla
- Instituto de Investigación Hospital 12 de Octubre (imas12) Madrid, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
| | - Rafael Segarra
- Hospital Universitario Cruces, Biocruces, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Bilbao, España
| | - Benedicto Crespo-Facorro
- Universidad de Cantabria, IDIVAL, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, España
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Llorca PM, Bobes J, Fleischhacker WW, Heres S, Moore N, Bent-Ennakhil N, Sapin C, Loze JY, Nylander AG, Patel MX. Baseline results from the European non-interventional Antipsychotic Long acTing injection in schizOphrenia (ALTO) study. Eur Psychiatry 2018; 52:85-94. [PMID: 29734130 DOI: 10.1016/j.eurpsy.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs. METHODS Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life. RESULTS For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight. CONCLUSIONS These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.
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Affiliation(s)
- Pierre-Michel Llorca
- University Hospital Center, EA 7280 University Clermont Auvergne, Clermont-Ferrand, France
| | - Julio Bobes
- Department of Psychiatry - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany
| | - Nicholas Moore
- Department of Pharmacology, University of Bordeaux, Bordeaux, France
| | | | | | - Jean-Yves Loze
- Otsuka Pharmaceutical Europe Ltd., Wexham, United Kingdom
| | | | - Maxine X Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Sruamsiri R, Mori Y, Mahlich J. Productivity loss of caregivers of schizophrenia patients: a cross-sectional survey in Japan. J Ment Health 2018; 27:583-587. [DOI: 10.1080/09638237.2018.1466048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Yasuhiro Mori
- Department of Psychiatry, Aichi Medical University, Nagakute, Japan, and
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical K.K, Tokyo, Japan,
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Kishimoto T, Hagi K, Nitta M, Leucht S, Olfson M, Kane JM, Correll CU. Effectiveness of Long-Acting Injectable vs Oral Antipsychotics in Patients With Schizophrenia: A Meta-analysis of Prospective and Retrospective Cohort Studies. Schizophr Bull 2018; 44:603-619. [PMID: 29868849 PMCID: PMC5890463 DOI: 10.1093/schbul/sbx090] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Compared with oral antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs) should improve medication adherence and reduce relapses in schizophrenia. However, meta-analyses of randomized trials and mirror-image studies yielded inconsistent results. Nonrandomized cohort studies with parallel comparisons of LAIs and OAPs offer a third design to examine this issue. We meta-analyzed cohort studies with ≥24 weeks duration and hospitalization data. Primary outcome was hospitalization rate, ie, number of hospitalizations per person-year. Secondary outcomes included hospitalization risk, ie, proportion of patients experiencing ≥1 hospitalizations, all-cause discontinuation, and total hospitalization days. Patient severity and/or chronicity at baseline was also meta-analyzed and explored as a potential effect size moderator. Altogether, 42 studies (n = 101 624; follow-up = 18.6 ± 10.0 mo) were meta-analyzed. LAIs were superior to OAPs regarding hospitalization rate (studies = 15, person-years = 68 009, rate ratio = 0.85, 95% CI = 0.78-0.93, P < .001) and all-cause discontinuations (studies = 10, n = 37 293, risk ratio = 0.78, 95% CI = 0.67-0.91, P = .001), but not regarding hospitalization risk (studies = 33, n = 51 733, risk ratio = 0.92, 95% CI = 0.84-1.00, P = .06), and hospitalization days (studies = 11, n = 21 328, Hedges' g = -0.05, 95% CI = -0.16 to 0.06, P = .39). Illness severity/chronicity was significantly greater in patients prescribed LAIs vs OAPs when all available information was pooled together (studies = 23, n = 61 806, Hedges' g = 0.15, 95% CI = 0.03-0.26, P = .01), but not when examined separately. In summary, this meta-analysis of cohort studies, which included patients that are broadly representative of clinical practice, indicates that LAIs are superior to OAPs. The lack of significant superiority of LAIs for hospitalization risk and hospital days needs to be interpreted in the context of naturalistic treatment selection with subsequently greater illness severity/chronicity in LAI-treated patients.
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Affiliation(s)
- Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Katsuhiko Hagi
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Masahiro Nitta
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
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Nordon C, Bovagnet T, Belger M, Jimenez J, Olivares R, Chevrou-Severac H, Verdoux H, Haro JM, Abenhaim L, Karcher H. Trial exclusion criteria and their impact on the estimation of antipsychotic drugs effect: A case study using the SOHO database. Schizophr Res 2018; 193:146-153. [PMID: 28712965 DOI: 10.1016/j.schres.2017.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the impact upon estimation of drug effect as a result of applying exclusion criteria in randomized-controlled trials (RCT) measuring the efficacy of antipsychotics (AP) in schizophrenia. METHODS Three characteristics which may act as effect-modifiers of AP, while also common exclusion criteria in RCTs, were identified through literature review: schizophrenia duration, substance use disorder and poor adherence. The SOHO cohort was used to estimate the effect of initiating antipsychotic drugs "A", "B" or "C" (pooled) upon symptom evolution at 3months from baseline (CGI-S scale). "Estimated effectiveness" and "estimated efficacy" were drawn from the "SOHO" and "RCT-like" (patients with none of the above-listed exclusion criteria) samples, respectively. Effect-modification and impact of each exclusion criterion on AP effect estimates were explored using non-adjusted statistics. RESULTS The "SOHO sample" included 8250 patients initiating drug A, B or C at baseline, whose AP "estimated effectiveness" was ΔCGI-S=-0.78 (95% CI=-0.80, -0.76). The "RCT-like" sub-sample included 5348 (65%) patients whose AP "estimated efficacy" was ΔCGI-S=-0.73 (95% CI=-0.75, -0.70). Patients with short illness duration (≤3years since first AP; n=2436) experienced significant symptom improvement (ΔCGI-S=-0.89; 95%CI=-0.93, -0.85) compared to patients with duration >3years (mean ΔCGI-S=-0.73; 95%CI=-0.76, -0.71). Excluding patients with short illness duration led to a change in AP effect estimates but this was not the case for substance use disorder or poor adherence. CONCLUSION Using certain exclusion criteria in RCTs may impact the drug's effect estimate, particularly when exclusion criteria are AP effect-modifiers representing frequent characteristics among patients with schizophrenia.
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Affiliation(s)
| | | | - Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, United Kingdom
| | - Javier Jimenez
- Medical Evidence and Observational Research, AstraZeneca, 1 Medimmune way, Gaithersburg, MD, United States
| | - Robert Olivares
- Global HEOR, Sanofi, 1 Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Helene Chevrou-Severac
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Glattpark-Opfikon, Zurich, Switzerland
| | - Helene Verdoux
- Univ. Bordeaux 2 and INSERM U1219, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
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Comparison of Paliperidone Palmitate and Risperidone Long-Acting Injection in Schizophrenic Patients: Results From a Multicenter Retrospective Cohort Study in France. J Clin Psychopharmacol 2018; 38:19-26. [PMID: 29232310 PMCID: PMC5737453 DOI: 10.1097/jcp.0000000000000827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE/BACKGROUND The study objective was to compare the impact of being treated by paliperidone palmitate (PP) or risperidone long-acting injection (RLAI) on the length of stay on initial hospitalization, rehospitalization risk, and treatment duration in schizophrenic patients. METHODS We conducted an observational retrospective cohort study in 43 centers in France, including schizophrenic patients who initiated a treatment by PP or RLAI during initial hospitalization. The follow-up periods started in September 2012 for the RLAI group (median follow-up duration, 233 days) and in June 2013 for the PP group (259 days). Statistical analyses were based on Cox regression models, with propensity score weighting to account for differences in patients' characteristics. FINDINGS/RESULTS The analysis included 347 patients: 197 in the PP treatment group and 150 in the RLAI group. Compared with patients on RLAI, patients on PP were significantly more likely to have nonpsychiatric comorbidities, to have been on previous antipsychotic therapy, or to have been hospitalized for psychiatric care in the previous year. With regard to length of stay on initial hospitalization, there was no statistically significant difference between both groups (hazard ratio, 1.13 [0.97; 1.31]). Being on PP was associated with similar times to first rehospitalization compared with RLAI (hazard ratio, 0.92 [0.65; 1.30]). IMPLICATIONS/CONCLUSIONS We observed nonsignificant differences in initial hospitalization duration and time to rehospitalization between PP and RLAI, potentially due to lack of statistical power. A trend was observed in favor of PP with regard to time to treatment discontinuation, although this result was compromised by patients who switched between RLAI and PP.
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Malandain L, Thibaut F, Grimaldi-Bensouda L, Falissard B, Abenhaim L, Nordon C. Correlates and predictors of antipsychotic drug polypharmacy in real-life settings: Results from a nationwide cohort study. Schizophr Res 2018; 192:213-218. [PMID: 28558905 DOI: 10.1016/j.schres.2017.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/01/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Abstract
Reasons for using antipsychotic polypharmacy (APP) in routine clinical practice, despite a potentially unfavorable risk-benefit ratio, are poorly understood. This research aimed to determine (1) if severe courses of schizophrenia were associated with APP and (2) if a schizophrenia-related acute event would predict a switch to APP in the short term. Observational prospective data (at baseline and 6months) were drawn from a French nationwide cohort ("Cohorte Générale Schizophrénie"), which included 1859 inpatients and outpatients with schizophrenia. APP was defined as the prescription of ≥2 antipsychotic drugs (there being different active substances). Early-onset schizophrenia, legal guardianship, higher lifetime maximal severity of illness and comorbid antisocial personality were used as proxies for severe courses of schizophrenia. Schizophrenia-related acute events included hospitalization and recent suicide attempts. Logistic regression models were used to determine (1) whether the use of APP at baseline (vs. monotherapy) was associated with a severe course of schizophrenia or not, independent of acute events, and (2) if a switch to APP at 6months (vs. remaining on monotherapy) was associated with acute events, independent of severe courses of schizophrenia. Increased odds of APP use at baseline were independently associated with legal guardianship (OR=1.6; 95%CI=1.3, 2.0) and higher lifetime maximum severity of illness (OR=1.3; 95%CI=1.2, 1.5). A switch to APP at 6months was predicted by a hospitalization occurring since baseline (OR=6.1; 95%CI=3.9, 9.4). In routine clinical practice, APP is more likely prescribed to patients with severe courses of illness, possibly indicating the difficulty to manage these patients.
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Affiliation(s)
| | - Florence Thibaut
- Cochin University Hospital (site Tarnier), 89 rue d'Assas, 75006 Paris, France; INSERM U894, CPN, 102-108 rue de la Sante, 75014 Paris, France; Paris-Descartes University, 15 rue de l'École de Médecine, 75006 Paris, France.
| | | | - Bruno Falissard
- Paris-Descartes University, 15 rue de l'École de Médecine, 75006 Paris, France; CESP, INSERM U1018, Maison des adolescents, 97 boulevard de Port-Royal, 75005 Paris, France; Paris-Sud University, Université Paris-Saclay, UVSQ, 78035 Versailles, France
| | - Lucien Abenhaim
- LASER, 3 rue de l'Arrivée, 75015, Paris, France; London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, United Kingdom
| | - Clementine Nordon
- LASER, 3 rue de l'Arrivée, 75015, Paris, France; CESP, INSERM U1018, Maison des adolescents, 97 boulevard de Port-Royal, 75005 Paris, France.
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Schoretsanitis G, de Leon J, Haen E, Stegmann B, Hiemke C, Gründer G, Paulzen M. Pharmacokinetics of risperidone in different application forms - Comparing long-acting injectable and oral formulations. Eur Neuropsychopharmacol 2018; 28:130-137. [PMID: 29153926 DOI: 10.1016/j.euroneuro.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/06/2017] [Accepted: 11/03/2017] [Indexed: 12/20/2022]
Abstract
We aimed to explore the differences in the pharmacokinetics of risperidone between oral and long-acting injectable (LAI) formulations using a large database of therapeutic drug monitoring (TDM). Plasma concentrations of risperidone (RIS), its active metabolite (9-OH-RIS) and the active moiety (AM) (RIS+9-OH-RIS), their concentration-to-dose (C/D) ratios and ratio of RIS/9-OH-RIS (an index of CYP2D6 metabolic activity) were used to compare patients receiving risperidone orally (n = 851) and those treated with LAI RIS (n = 63). Patients taking CYP inducers or inhibitors or with liver/renal impairment were eliminated. Our study demonstrated that patients on LAI RIS, despite slightly higher RIS doses in the oral group, showed no significant differences in total AM or 9-OH-RIS. Conversely, RIS concentration, RIS C/D ratio and total C/D ratio were slightly higher in the LAI RIS group, reaching significance due to the large sample size. More importantly, the median ratio of RIS/9-OH-RIS was 0.52 in LAI RIS vs. 0.25 in the oral group, providing a significant difference (p < 0.001). After controlling for confounding factors, we replicated the RIS/9-OH-RIS ratio increases in patients with LAI RIS, probably reflecting a decrease in first-pass metabolism. More studies are required to establish the clinical use of TDM for patients on LAI RIS.
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Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry, Bern, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany.
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, 18971 Granada, Spain; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, 01004 Vitoria, Spain
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Benedikt Stegmann
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany
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Cheung S, Hamuro Y, Mahlich J, Nakahara T, Sruamsiri R, Tsukazawa S. Drug Utilization of Japanese Patients Diagnosed with Schizophrenia: An Administrative Database Analysis. Clin Drug Investig 2017; 37:559-569. [PMID: 28361438 PMCID: PMC5422449 DOI: 10.1007/s40261-017-0517-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and objective Patient characteristics require consideration for optimal treatment in order to achieve clinical remission for an improved quality of life and social functioning. Prior evidence supports long-acting injectable antipsychotics (LAIs) in the relapse prevention of schizophrenia. This study aimed to characterize Japanese patients diagnosed with schizophrenia and to compare the outcomes of LAIs and oral antipsychotics (AP) in re-hospitalization or emergency room visit rates. Methods Diagnostic Procedure Combination (DPC) designated hospital data in Japan with ICD-10 code F20x between July 2013 and June 2015 were obtained from the Medical Data Vision Co. Ltd. Patients were divided into sub-groups in order to filter co-diagnostic conditions. Differences across sub-groups were assessed using a Chi square test or ANOVA. The incidence rate ratio (IRR) was calculated to compare the re-hospitalization (30 days post discharge) or emergency room visit rates between pharmacotherapy groups of oral versus LAI or typical versus atypical within LAI patients. Adjusted estimates were provided by propensity scores that were assigned for age, gender, and Charlson co-morbidity index (CCI) scores. Results A quarter of the data sourced were attributed to co-diagnosis with dementia/delirium with antipsychotic prescriptions despite reported risks of antipsychotic use. After adjusting for age, gender, and co-morbidity, LAI reduced re-hospitalization and emergency (ER) visit rates more than oral APs (LAI vs. oral IRR = 0.38 (95% CI 0.17–0.74), IRR = 0.56 (95% CI 0.34–0.91), respectively). Conclusion The study findings demonstrate usage of DPC hospital data in schizophrenia pharmacotherapy based on classification of co-diagnoses. In comparison with oral APs only, LAI utilization can provide an opportunity for reduced re-hospitalization and ER visit rates among patients with schizophrenia.
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Affiliation(s)
| | | | - Jörg Mahlich
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany. .,Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.
| | | | - Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
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Bustamante LHU, Cerqueira RO, Leclerc E, Brietzke E. Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. ACTA ACUST UNITED AC 2017; 40:220-225. [PMID: 29069252 PMCID: PMC6900760 DOI: 10.1590/1516-4446-2017-2290] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. METHODS The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. RESULTS Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. CONCLUSIONS Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.
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Affiliation(s)
- Lineth H U Bustamante
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Raphael O Cerqueira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Emilie Leclerc
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elisa Brietzke
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Chartier F, Rouillon F, Berggren L, Jamonneau I, Falissard B, Llorca P. Follow-up study of patients treated with olanzapine pamoate in France in real-life treatment situation. Encephale 2017; 43:303-310. [DOI: 10.1016/j.encep.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/15/2017] [Accepted: 05/21/2017] [Indexed: 11/26/2022]
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Druais S, Doutriaux A, Cognet M, Godet A, Lançon C, Levy P, Samalin L, Guillon P. Comparaison des bénéfices médico-économiques des antipsychotiques dans la prise en charge de la schizophrénie en France. Encephale 2017; 43:311-320. [DOI: 10.1016/j.encep.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022]
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Decuypere F, Sermon J, Geerts P, Denee TR, De Vos C, Malfait B, Lamotte M, Mulder CL. Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study. PLoS One 2017; 12:e0179049. [PMID: 28614404 PMCID: PMC5470699 DOI: 10.1371/journal.pone.0179049] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
Achieving greater continuation of treatment is a key element to improve treatment outcomes in schizophrenia patients. However, reported treatment continuation can differ markedly depending on the study design. In a retrospective setting, treatment continuation remains overall poor among patients using antipsychotics. This study aimed to document the difference in treatment continuation between four long-acting injectable antipsychotics based on the QuintilesIMS LRx databases, national, longitudinal, panel based prescription databases of retail pharmacies, in the Netherlands and Belgium. Paliperidone palmitate once monthly, risperidone microspheres, haloperidol decanoate, and olanzapine pamoate were studied. This study demonstrated significantly higher treatment continuation of paliperidone palmitate once monthly compared to risperidone microspheres (p-value<0,01) and haloperidol decanoate (p-value<0,01) in both countries, a significantly higher treatment continuation of paliperidone palmitate once monthly compared to olanzapine pamoate in the Netherlands (p-value<0,01), and a general trend towards better treatment continuation versus olanzapine pamoate in Belgium. Analysing the subgroup of patients without previous exposure to long-acting antipsychotic treatment revealed the positive impact of previous exposure on treatment continuation with a subsequent long acting treatment. Additionally, the probability of restarting the index therapy was higher among patients treated with paliperidone palmitate once monthly compared to patients treated with risperidone microspheres and haloperidol decanoate. The data source used and the methodology defined ensured for the first time a comparison of treatment continuation in a non-interventional study design for the four long-acting injectable antipsychotics studied.
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Affiliation(s)
| | - Jan Sermon
- Health Economics, Market Access, Reimbursement, Janssen-Cilag NV, Beerse, Belgium
| | - Paul Geerts
- Medical Affairs, Janssen-Cilag NV, Beerse, Belgium
| | - Tom R. Denee
- Health Economics, Market Access, Reimbursement, Janssen-Cilag BV, Tilburg, Netherlands
| | - Cedric De Vos
- Health Economics, Market Access, Reimbursement, Janssen-Cilag NV, Beerse, Belgium
| | - Bart Malfait
- Health Economics, Market Access, Reimbursement, Janssen-Cilag NV, Beerse, Belgium
| | - Mark Lamotte
- Real-World Evidence Solutions, QuintilesIMS, Zaventem, Belgium
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Fakra E, Azorin JM, Belzeaux R, Adida M, Blin O, Kaladjian A. [Evaluating the efficacy of long acting injectable antipsychotics through clinical trials]. Encephale 2017; 42:S43-S46. [PMID: 28236992 DOI: 10.1016/s0013-7006(17)30053-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
After reminding the various phases of the development of molecules, this article will state the stages of commercialisation of treatments, underlining the FDA (Food and Drug Administration) and the EMA (European Medicine Agency) requirements. Like all the other treatments available in Europe and in the United States, the long acting injectable antipsychotics (LAI) have to prove their efficacy compared to placebo and their non-inferiority compared to a treatment of reference, usually the same molecule in the oral form. These criteria of efficacy have evolved over time. If initially classical criteria of symptomatic intensity (score on scale PANSS) were considered, criteria more adequate from a clinical perspective, such as relapse, but also related to functioning, quality of life and, more recently, costs-effectiveness have appeared. This evolution is probably due to several factors: vision on mental illness, progress in patient's rights and aspirations, but also the pregnant place of health costs recently taken in the evaluation of treatments. These modifications are also based on the indications of L.A.I., i.e. stabilized patients for whom the challenge is rehabilitation care more than the control of symptoms.
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Affiliation(s)
- E Fakra
- Service de Psychiatrie Adultes, CHU Saint-Etienne, 5 Chemin de la Marendière, 42055 Saint-Étienne Cedex 2, France.
| | - J-M Azorin
- SHU Psychiatrie Adultes, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France
| | - R Belzeaux
- SHU Psychiatrie Adultes, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France
| | - M Adida
- SHU Psychiatrie Adultes, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France
| | - O Blin
- Centre de Pharmacologie Clinique et Evaluation Thérapeutiques (APHM), UHC « La Timone », 28 bd Bd Jean Moulin, 13385 Marseille, France
| | - A Kaladjian
- Pôle de Psychiatrie des Adultes, CHU Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex, France
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[How to assess curative and/or preventive effects of psychotropic drugs?]. Encephale 2017; 42:S33-S42. [PMID: 28236991 DOI: 10.1016/s0013-7006(17)30052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Proving the efficacy of a psychotropic drug is a medical, scientific and ethical need. Psychotropic drug development is now a highly complex process, which takes several years and which is very expensive. It involves multiple steps of preclinical and clinical pharmacological refinement and testing. Methodology of studies to prove curative or preventive effect of psychotropic drugs is well codified. Preclinical studies include pharmacokinetic data, toxicology and performance in various animal models of pathology. Clinical phases are centered on randomized controlled double blind trials for demonstrating efficacy and safety/tolerability. This methodology follows strict criteria to avoid bias and to prove internal and external validity of the results. All the results from randomized controlled trials or RCTs lead to different levels of evidence of Evidence-Based Medicine (EBM): gold standard is RCTs while the lowest reference is clinical case or expert opinion. However, it is possible to level criticism at these data issued from RCTs. The main matter is that studies do not reflect the healthcare reality in daily life. For these reasons, a real debate between evaluation of efficacy and effectiveness is acute. Effectiveness refers to the overall effects of psychotropic drugs in naturalistic conditions. Furthermore, analysis of costs and financial benefits are more and more important from social and economic points of view. Official agencies and health insurances look after them very carefully. This article deals with these issues and provides examples using data from the international literature. These examples are drawn from RCTs, naturalistic studies, meta-analysis, pharmaco-economic studies and concern neuroleptics, antipsychotics, antidepressants, and mood-stabilizers.
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Ali A, Carre A, Orri M, Urbach M, Barry C, Hassler C, Falissard B, Berthoz S, Nordon C. The real-life effectiveness of psychosocial therapies on social autonomy in schizophrenia patients: Results from a nationwide cohort study in France. Psychiatry Res 2017; 247:97-104. [PMID: 27886580 DOI: 10.1016/j.psychres.2016.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/20/2016] [Accepted: 10/23/2016] [Indexed: 12/15/2022]
Abstract
The objectives of the present study were to describe the prescribing patterns for psychosocial therapies in routine clinical practice and to assess the impact of psychoeducation on symptoms and social autonomy of patients with schizophrenia. We used data from the nationwide French ESPASS observational cohort study including 5967 patients with schizophrenia, which provided data on exposure to psychosocial therapies from 4961 (83%) participants. Patients who initiated psychosocial therapy within the first 3 months of study onset (n=143) were compared to patients not subject to psychosocial therapy throughout follow up (n=4268), using parametric tests. Symptom severity and social autonomy at 6 months from baseline were compared between patients undergoing psychoeducation (n=117) and patients not subject to psychosocial therapy, matched (1:1) on propensity scores. Patients who initiated psychosocial therapy were significantly younger, more severely ill and used less often antipsychotic drugs than patients in the reference group. At 6 months, patients who initiated psychoeducation and their matched referents did not differ significantly in terms of symptom severity, but their level of improvement in social autonomy was significantly greater (p=0.005). In routine clinical practice, psychoeducation in addition to antipsychotic drugs provides some benefit among schizophrenia patients, particularly in terms of social autonomy.
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Affiliation(s)
- Aminata Ali
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Arnaud Carre
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France; Savoie Mont Blanc University, LIPP C2S EA 4145, Domaine Universitaire de Jacob, BP1104, 73000 Chambéry, France
| | - Massimiliano Orri
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Mathieu Urbach
- Centre Expert Schizophrénie, Versailles Hospital Centre,177 rue de Versailles, 78157 Le Chesnay cedex, France
| | - Caroline Barry
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Christine Hassler
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Bruno Falissard
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Sylvie Berthoz
- Institute for Cognitive and Integrative Neuroscience, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - Clementine Nordon
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France; LASER Analytica, 10 place de Catalogne, 75014 Paris, France.
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Nakamura Y, Mahlich J. Productivity and deadweight losses due to relapses of schizophrenia in Japan. Neuropsychiatr Dis Treat 2017; 13:1341-1348. [PMID: 28553120 PMCID: PMC5439971 DOI: 10.2147/ndt.s138033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND No study has examined the financial impact of relapses on schizophrenia from the perspective of Japanese society. This study aimed to estimate the societal costs in Japan caused by the relapses of schizophrenia. METHODS The societal costs in Japan in 2013 due to relapses of schizophrenia were estimated by summing the productivity loss and deadweight loss caused by schizophrenia relapses in 2013. Deterministic sensitivity analysis was conducted for deadweight loss rate, relapse rate, and patient income. RESULTS Japan incurred JPY 55,039 million societal costs because of relapses in 2013. This consists of JPY 3,990 million for productivity loss and JPY 51,049 million for deadweight loss. Rate of deadweight loss is the most significant cost driver in the sensitivity analysis. CONCLUSION Relapses of schizophrenia could generate huge amount of societal costs by reducing labor productivity and economic efficiency. To curb these costs, relapse prevention is desired in treating schizophrenia.
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Affiliation(s)
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical K.K., Tokyo, Japan.,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Clinical trial methodology to assess the efficacy/effectiveness of long-acting antipsychotics: Randomized controlled trials vs naturalistic studies. Psychiatry Res 2017; 247:257-264. [PMID: 27936437 DOI: 10.1016/j.psychres.2016.11.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/26/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
Abstract
Schizophrenia presents unique difficulties in clinical trial design associated with the condition's variable presentation and clinical course, and multiple features influencing affect, cognition, volition and perception. Randomized controlled trials (RCTs) are explanatory studies using a carefully selected patient population, predefined assessment intervals and, generally, symptom-focused endpoints. Naturalistic studies are pragmatic, with no active intervention, and outcomes that are generally those used in clinical practice (e.g. hospitalization, relapse rate). Both naturalistic studies and RCTs have pros and cons, making it difficult for physicians in clinical practice to apply research findings to their own treatment decisions. The choice of clinical trial design can have a significant impact on the comparative effectiveness or efficacy of drugs. This is particularly true for studies comparing long-acting injectable (LAI) antipsychotics with oral antipsychotics in schizophrenia, in which RCTs generally show no benefit for LAIs over oral drugs, whereas observational studies do. The more pragmatic the study design, the more likely it is to show a benefit for LAIs versus oral therapy. This article reviews the pros and cons of different study types, using published examples. Criteria are outlined to help physicians design appropriate prospective studies in schizophrenia including the relevant pragmatic and/or explanatory features, as required.
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Wu CS, Cheng IC, Feng J, Chen CL. Comparison of treatment effectiveness and medical costs for different long-acting injectable antipsychotics in patients with schizophrenia in Taiwan: A nationwide population-based cohort study. Schizophr Res 2016; 173:37-44. [PMID: 26987938 DOI: 10.1016/j.schres.2016.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the comparative effectiveness and medical costs of five long-acting injectable (LAI) antipsychotics, flupentixol, fluphenazine, haloperidol, risperidone, and clopentixol/zuclopentixol, in patients with schizophrenia. METHOD We conducted a retrospective cohort study of patients with schizophrenia using data from Taiwan's National Health Insurance Research Database. Patients aged 15years or older who began treatment with LAI antipsychotics between June 1, 2004 and December 31, 2008 were enrolled and followed for 1year. We evaluated the medical costs and treatment effectiveness, which was assessed using the rates of treatment discontinuation, psychiatric hospitalization, and emergency department visits. Risperidone was used as a reference group. RESULTS Compared to risperidone, flupentixol was associated with higher hazard ratios of treatment discontinuation and psychiatric hospitalization, fluphenazine was associated with higher hazard ratios of treatment discontinuation, and haloperidol was associated with higher rates of psychiatric hospitalization and emergence department visits. However, fluphenazine, flupentixol, and haloperidol were associated with lower medical costs compared to risperidone. Clopentixol/zuclopentixol was inferior to risperidone in treatment effectiveness and medical cost. CONCLUSIONS Our findings suggest that patients taking the LAI risperidone may be more effective in some but not all outcome measures; however, risperidone was also associated with higher medical costs in the Taiwanese healthcare setting.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Chih Cheng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung Feng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Lin Chen
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Druais S, Doutriaux A, Cognet M, Godet A, Lançon C, Levy P, Samalin L, Guillon P. Cost Effectiveness of Paliperidone Long-Acting Injectable Versus Other Antipsychotics for the Maintenance Treatment of Schizophrenia in France. PHARMACOECONOMICS 2016; 34:363-391. [PMID: 26883132 PMCID: PMC4796324 DOI: 10.1007/s40273-015-0348-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND French clinical recommendations suggest prescribing long-acting injectable (LAI) antipsychotics to patients with a maintenance treatment indication in schizophrenia. Despite this, and due to their relatively high acquisition and administration costs, LAIs are still underused in clinical practice in France, thus highlighting the need for pharmacoeconomic evaluations. OBJECTIVE Our objective was to estimate the cost effectiveness of paliperidone LAI (or paliperidone palmitate), a once-monthly second-generation LAI antipsychotic, compared with the most common antipsychotic medications for the maintenance treatment of schizophrenia in France. METHODS A Markov model was developed to simulate the progression of a cohort of schizophrenic patients through four health states (stable treated, stable non-treated, relapse and death) and to consider up to three lines of treatment to account for changes in treatment management. Paliperidone LAI was compared with risperidone LAI, aripiprazole LAI, olanzapine LAI, haloperidol LAI (or haloperidol decanoate) and oral olanzapine. Costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over 5 years based on 3-month cycles with a discount rate of 4% and from a French health insurance perspective. Patients were considered to be stabilised after a schizophrenic episode and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on real-life French data to capture adherence effects. Safety and utility data were derived from international publications. Additionally, costs were retrieved from French health insurance databases and publications. Finally, expert opinion was used for validation purposes or in case of gaps in data. The robustness of results was assessed through deterministic and probabilistic sensitivity analyses. RESULTS All LAI antipsychotics were found to have similar costs over 5 years: approximatively €55,000, except for paliperidone LAI which had a discounted cost of €50,880. Oral olanzapine was less costly than LAIs (i.e. €50,379 after 5 years) but was associated with fewer QALYs gained and relapses avoided. Paliperidone LAI dominated aripiprazole LAI, olanzapine LAI and haloperidol LAI in terms of costs per QALY, and it was associated with slightly fewer QALYs when compared with risperidone LAI (i.e. 3.763 vs 3.764). This resulted in a high incremental cost-effectiveness ratio (ICER) (i.e. €4,770,018 per QALY gained) for risperidone LAI compared with paliperidone LAI. Paliperidone LAI was more costly than olanzapine oral but associated with more QALYs (i.e. ICER of €2411 per QALY gained for paliperidone LAI compared with oral olanzapine). Paliperidone LAI had a probability of being the optimal strategy in more than 50% of cases for a willingness-to-pay threshold of €8000 per QALY gained. CONCLUSION This analysis, to the best of our knowledge, is the first of its kind to assess the cost effectiveness of antipsychotics based on French observational data. Paliperidone LAI appeared to be a cost-effective option in the treatment of schizophrenia from the French health insurance perspective.
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Affiliation(s)
- Sylvain Druais
- Amaris, 204 rue du Saint-Sacrement, Espace Rezomont 3ième étage, Montréal, QC H2Y 1W8, Canada.
| | | | | | | | | | | | - Ludovic Samalin
- CHU Clermont-Ferrand, University of Auvergne, EA 7280, Clermont-Ferrand, France
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Fagiolini A, Alfonsi E, Amodeo G, Cenci M, Di Lella M, Farinella F, Ferraiuolo F, Fraguas D, Loparco N, Gutierrez-Rojas L, Mignone ML, Pataracchia G, Pillai G, Russo F, Sanchez-Gistau V, Spinogatti F, Toscano M, Villari V, De Filippis S. Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists. Expert Opin Drug Saf 2016; 15:449-55. [DOI: 10.1517/14740338.2016.1155553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea Fagiolini
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Emilia Alfonsi
- Department of Mental Health, National Health Service, Ancona, Italy
| | - Giovanni Amodeo
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Mario Cenci
- Department of Mental Health, Fabriano, Italy
| | - Michele Di Lella
- Department of Mental Health, National Health Service, Alessandria, Italy
| | | | | | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Madrid, Spain
| | - Natale Loparco
- Department of Mental Health, National Health Service, Taranto, Italy
| | - Luis Gutierrez-Rojas
- Departamento de Psiquiatría, Hospital Clínico, Granada - Complejo Hospitalario Granada, Granada, Spain
| | | | | | - Gianluca Pillai
- Department of Mental Health, National Health Service, Oristano, Italy
| | - Felicia Russo
- Servizio Psichiatrico di Diagnosi e Cura, Ospedale F. Fallacara, Triggiano and Department of Mental Health, National Health Service, Bari, Italy
| | - Vanessa Sanchez-Gistau
- Early Intervention Psychosis Service, Hospital Universitari Insitut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Franco Spinogatti
- Department of Mental Health, National Health Service, Cremona, Italy
| | - Marco Toscano
- Department of Mental Health, ASST Rhodense, Garbagnate M.se, Italy
| | - Vincenzo Villari
- Department of Mental Health, National Health Service, Torino, Italy
| | - Sergio De Filippis
- Casa di Cura Neuropsichiatrica e Comunità Terapeutica-Genzano, University of Rome and Villa Von Siebenthal, Rome, Italy
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Spaniel F, Novak T, Bankovska Motlova L, Capkova J, Slovakova A, Trancik P, Matejka M, Höschl C. Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system. J Psychiatr Ment Health Nurs 2015; 22:811-20. [PMID: 26176646 DOI: 10.1111/jpm.12251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 01/05/2023]
Abstract
ACCESSIBLE SUMMARY Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. ABSTRACT The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group (n = 72). In the active arm, investigators increased the antipsychotic dose upon occurrence of prodrome announced by the system. Intention-to-treat analysis showed no between-group difference in the hospitalization-free survival rate [Kaplan-Meier method; hazard ratio (HR) = 1.21, 95% confidence interval (CI): 0.56-2.61, P = 0.6). In a post hoc multivariate Cox proportional hazards model, out of 13 potential predictors, only ITAREPS-related variables (number of alerts without pharmacological intervention/HR = 1.38, P = 0.042/ and patient non-adherence with ITAREPS /HR = 1.08, P = 0.009/) increased the risk of hospitalization. In this trial ITAREPS was not effective. The results in context with previous ITAREPS studies suggest non-adherence of both psychiatrists and patients as the main reasons for the failure of this preventive strategy. Tertiary prevention in schizophrenia have to be regarded a major challenge, warranting the need for implementation of strategies with more active participation of both patient and treating psychiatrist.
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Affiliation(s)
- F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Novak
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Bankovska Motlova
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Capkova
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Slovakova
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - P Trancik
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Matejka
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
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Schreiner A, Aadamsoo K, Altamura AC, Franco M, Gorwood P, Neznanov NG, Schronen J, Ucok A, Zink M, Janik A, Cherubin P, Lahaye M, Hargarter L. Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia. Schizophr Res 2015; 169:393-399. [PMID: 26431793 DOI: 10.1016/j.schres.2015.08.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Relapse and acute exacerbation are common in schizophrenia and may impact treatment response and outcome. Evidence is conflicting in respect to superiority of long-acting injectable antipsychotic therapies versus oral antipsychotics in relapse prevention. This randomized controlled study assessed the efficacy of paliperidone palmitate versus oral antipsychotics for relapse prevention. METHOD Eligible patients with a recent diagnosis of schizophrenia (within 1-5 years) were randomized 1:1 to paliperidone palmitate (n=376) or oral antipsychotic monotherapy (n=388) and entered a 2-week initial acute oral treatment phase. Patients who met predefined response criteria were eligible to enter the 24-month rater-blinded core treatment phase. Patients were evaluated for relapse, symptoms, functioning, quality of life, treatment satisfaction, and tolerability. RESULTS In the core treatment phase, time to relapse was significantly longer in the paliperidone palmitate (n=352) compared with the oral antipsychotics arm (n=363): 85% of patients were relapse-free at 469 versus 249 days (P=0.019). Significantly fewer patients receiving paliperidone palmitate met the relapse criteria (52 [14.8%] versus 76 [20.9%, oral antipsychotics]; P=0.032), representing a 29.4% relative risk reduction. For paliperidone palmitate, a significantly greater improvement in Positive and Negative Syndrome Scale total score on Day 8 (P=0.021) and a trend at endpoint (P=0.075) were observed. Functioning improvements were comparable between treatment arms. No new safety signals were identified. CONCLUSION The observed time to relapse superiority of paliperidone palmitate over oral antipsychotics provides further evidence for the value of long-acting injectable antipsychotic therapies in the treatment of schizophrenia, including during the early stages of illness.
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Affiliation(s)
| | - Kaire Aadamsoo
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuel Franco
- Psychiatric Department, Zamora Hospital, Zamora, Spain
| | - Philip Gorwood
- Hôpital Sainte-Anne, Paris Descartes University (INSERM U894), France
| | - Nikolaj G Neznanov
- St Petersburg V.M. Bekhterev Psychoneurological Research Institute, St Petersburg, Russia
| | | | - Alp Ucok
- Istanbul Medical Faculty, Istanbul, Turkey
| | - Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Adam Janik
- Global Clinical Operations, Janssen-Cilag, Warsaw, Poland
| | - Pierre Cherubin
- Medical Affairs, Janssen Cilag EMEA, Issy-les-Moulineaux, France
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Kruse G, Wong BJO, Duh MS, Lefebvre P, Lafeuille MH, Fastenau JM. Systematic Literature Review of the Methods Used to Compare Newer Second-Generation Agents for the Management of Schizophrenia: A focus on Health Technology Assessment. PHARMACOECONOMICS 2015; 33:1049-1067. [PMID: 25963579 DOI: 10.1007/s40273-015-0285-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The challenges of comparative effectiveness to support health technology assessment (HTA) agencies are important considerations in the choices of antipsychotic medications for the treatment of schizophrenia. OBJECTIVES Our aim was to assess the study methods used and outcomes reported in the published literature to address the question of comparative effectiveness of newer antipsychotic agents and the adequacy and availability of evidence to support HTA agencies. DATA SOURCE A systematic search of the PubMed database from 1 January 2009 to 30 September 2013 was conducted to identify studies evaluating new atypical antipsychotics reporting on comparative effectiveness. STUDY SELECTION The systematic review comprised of studies on schizophrenia patients where at least two drugs were being compared and at least one treatment group received one of the following second-generation antipsychotics: risperidone, olanzapine, aripiprazole, paliperidone, asenapine, iloperidone, lurasidone, and quetiapine. The included studies were also required to have an efficacy, safety or economic outcome, such as Positive and Negative Syndrome Scale (PANSS) score, weight gain, resource utilization, or costs. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers (BW and GK) independently applied the inclusion criteria. Disagreements between reviewers were resolved by consensus, referring to the original sources. Information on the methodology and outcomes was collected for each included study. This included study description, head-to-head drug comparison, patient population, study methodology, statistical methods, reported outcomes, study support, and journal type. RESULTS A total of 198 studies were identified from electronic search methods. The largest category of studies was randomized controlled trials [RCTs] (N = 73; 36.9%), which were largely directed at the regulatory endpoint. Fewer studies were undertaken for HTA-purposes cohort studies (N = 53; 26.8%), meta-analyses (N = 32; 16.2%), economic studies (N = 14; 7.1%), and cross-sectional studies (N = 13; 6.6%). Direct head-to-head comparisons preferred by HTA were dominated by the comparison involving olanzapine and risperidone, representing 149 (75.3%) and 119 (60.1%) studies, respectively. RCTs, which are the primary study type for regulatory submissions, showed a lack of bias. Studies aimed at HTA were not as well performed. Cohort studies suffered from bias in the selection of comparison groups, lack of control for confounders, and differential dropout rates. As a group, cross-sectional studies scored poorly for bias, with a primary failure to identify a representative sample. Economic studies showed highly variable bias, with bias in the representation of effectiveness data, model assumptions without validation, and lack of sensitivity analyses. LIMITATIONS One limitation of this systematic review is that it only included studies from 2009 to 2013, potentially excluding some earlier comparator studies, particularly those involving first-generation antipsychotics. CONCLUSIONS This review of comparative effectiveness studies of second-generation antipsychotic agents for schizophrenic patients revealed a wide range of study types, study methodologies, and outcomes. For traditional efficacy outcomes and select safety outcomes, there is strong evidence from many well-conducted studies; however, there are fewer studies of types preferred by HTA with limited head-to-head comparisons and a higher risk of bias in the execution of these studies.
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Affiliation(s)
- Gregory Kruse
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce J O Wong
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mei Sheng Duh
- Analysis Group, Inc., Tenth Floor, 111 Huntington Avenue, Boston, MA, 02199, USA.
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Bossie CA, Alphs LD, Correll CU. Long-acting injectable versus daily oral antipsychotic treatment trials in schizophrenia: pragmatic versus explanatory study designs. Int Clin Psychopharmacol 2015; 30:272-81. [PMID: 26049673 PMCID: PMC4525810 DOI: 10.1097/yic.0000000000000082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trial design characteristics related to the explanatory : pragmatic spectrum may contribute toward the inconsistent results reported in studies comparing long-acting injectable (LAI) versus daily oral antipsychotic (AP) treatments in schizophrenia. A novel approach examined the hypothesis that a more pragmatic design is important to show the advantages of LAI versus oral APs. A literature search identified comparative studies assessing the clinical efficacy/effectiveness of LAI versus oral APs in more than 100 schizophrenia patients, with 6-month or more duration/follow-up, and published between January 1993 and December 2013 (n=11). Each study's design was rated using the six-domain ASPECT-R (A Study Pragmatic : Explanatory Characterization Tool-Rating). Nonparametric Wilcoxon rank-sum tests compared ratings of studies supporting (n=7) and not supporting (n=4) a LAI advantage. ASPECT-R total and domain scores were significantly higher (more pragmatic) in studies finding a LAI versus oral AP treatment advantage than those that did not. The rank order of this significance among domains was as follows: 'participant compliance assessment' (P=0.005), 'medical practice setting/practitioner expertise' (P=0.006), 'intervention flexibility' (P=0.007), 'follow-up intensity/duration' (P=0.009), 'primary trial outcomes' (P=0.012), and 'participant eligibility' (P=0.015). Findings support that more pragmatic, less explanatory design features are important to show advantages for LAI treatment. Explanatory studies may introduce features that obscure advantages related to adherence.
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Affiliation(s)
| | | | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks,Hofstra-North Shore LIJ School of Medicine, Hempstead, New York, USA
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Schreiner A, Bergmans P, Cherubin P, Keim S, Llorca PM, Cosar B, Petralia A, Corrivetti G, Hargarter L. Paliperidone palmitate in non-acute patients with schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot antipsychotics. J Psychopharmacol 2015; 29:910-22. [PMID: 25999398 PMCID: PMC4512527 DOI: 10.1177/0269881115586284] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PALMFlexS, a prospective multicentre, open-label, 6-month, phase IIIb interventional study, explored tolerability, safety and treatment response in adults (n = 231) with non-acute but symptomatic schizophrenia switching to flexibly dosed paliperidone palmitate (PP) after unsuccessful treatment with risperidone long-acting injectable therapy (RLAT) or conventional depot antipsychotics (APs). Treatment response was measured by change in Positive and Negative Syndrome Scale (PANSS) total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events. Significant reductions in mean PANSS total score were observed for all groups (-7.5 to -10.6; p ⩽ 0.01 [BL to LOCF EP]). After switching to PP, more than 50% of all patients achieved ⩾20% and one-third of RLAT-treated patients even achieved ⩾50% improvement in PANSS total score. Across groups, there were significant improvements (p < 0.05) in symptom severity as measured by Clinical Global Impression-Severity (CGI-S; trend for improvement with RLAT; p = 0.0568), subjective well-being, medication satisfaction, and patient functioning with PP. PP was generally well tolerated. Clinically relevant benefits were observed in non-acute patients with schizophrenia switched from RLAT or conventional depot APs to PP.
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Affiliation(s)
- A Schreiner
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
| | - P Bergmans
- Biometrics & Reporting, Janssen Cilag Benelux, Tilburg, the Netherlands
| | - P Cherubin
- EMEA Medical Affairs, Janssen Cilag, Issy-les-Moulineaux, France
| | - S Keim
- Global Clinical Operations EMEA Medical Affairs, Janssen Cilag, Barcarena, Portugal
| | - P-M Llorca
- CHRU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - B Cosar
- Gazi University Medical Faculty, Ankara, Turkey
| | - A Petralia
- UOPI of Psychiatry, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - G Corrivetti
- UOSM Distretto D, Pontecagnano-Faiano (Sa), Italy
| | - L Hargarter
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
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De Hert M, Sermon J, Geerts P, Vansteelandt K, Peuskens J, Detraux J. The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics. CNS Drugs 2015; 29:637-58. [PMID: 26293744 DOI: 10.1007/s40263-015-0269-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although continuous treatment with antipsychotics is still recommended as the gold standard treatment paradigm for all patients with schizophrenia, some clinicians question whether continuous antipsychotic treatment is necessary, or even justified, for every patient with schizophrenia who has been stabilized on antipsychotics. OBJECTIVE The primary objectives of this systematic review and meta-analysis were (i) to compare relapse/hospitalization risks of stabilized patients with schizophrenia under active versus intermittent or placebo treatment conditions; (ii) to examine the role of several study characteristics, possibly intervening in the relationship between relapse risk and treatment condition; and (iii) to examine whether time to relapse is associated with antipsychotic treatment duration. METHODS A systematic literature search, using the MEDLINE database (1950 until November 2014), was conducted for English-language published randomized controlled trials, covering a follow-up time period of at least 6 months, and investigating relapse/rehospitalization and/or time-to-relapse rates with placebo or intermittent treatment strategies versus continuous treatment with oral and long-acting injectable first- or second-generation antipsychotics (FGAs/SGAs) in stabilized patients with schizophrenia. Additional studies were identified through searches of reference lists of other identified systematic reviews and Cochrane reports. Two meta-analyses (placebo versus continuous and intermittent versus continuous treatment) were performed to obtain an optimal estimation of the relapse/hospitalization risks of stabilized patients with schizophrenia under these treatment conditions and to assess the role of study characteristics. For time-to-relapse data, a descriptive analysis was performed. RESULTS Forty-eight reports were selected as potentially eligible for our meta-analysis. Of these, 21 met the inclusion criteria. Twenty-five records, identified through Cochrane and other systematic reviews and fulfilling the inclusion criteria, were added, resulting in a total of 46 records. Stabilized patients with schizophrenia who have been exposed for at least 6 months to intermittent or placebo strategies, respectively, have a 3 (odds ratio [OR] 3.36; 95% CI 2.36-5.45; p < 0.0001) to 6 (OR 5.64; 95% CI 4.47-7.11; p < 0.0001) times increased risk of relapse, compared with patients on continuous treatment. The availability of rescue medication (p = 0.0102) was the only study characteristic explaining systematic differences in the OR for relapse between placebo versus continuous treatment across studies. Studies reporting time-to-relapse data show that the time to (impending) relapse is always significantly delayed with continuous treatment, compared with placebo or intermittent treatment strategies. Although the interval between treatment discontinuation and symptom recurrence can be highly variable, mean time-to-relapse data seem to indicate a failure of clinical stability before 7-14 months with intermittent and before 5 months with placebo treatment strategies. For all reports included in this systematic review, median time-to-relapse rates in the continuous treatment group were not estimable as <50% of the patients in this treatment condition relapsed before the end of the study. CONCLUSIONS With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.
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Affiliation(s)
- Marc De Hert
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Jan Sermon
- Janssen-Cilag NV, Health Economics, Market Access and Reimbursement-Neuroscience, 2340, Beerse, Belgium
| | - Paul Geerts
- Janssen-Cilag NV, Medical Affairs-Psychiatry, 2340, Beerse, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Joseph Peuskens
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Johan Detraux
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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Mahlich J, Nishi M, Saito Y. Modeling the budget impact of long-acting injectable paliperidone palmitate in the treatment of schizophrenia in Japan. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:267-72. [PMID: 26045674 PMCID: PMC4447166 DOI: 10.2147/ceor.s85514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The cost of schizophrenia in Japan is high and new long-acting injectable (LAI) antipsychotics might be able to reduce costs by causing a reduction of hospital stays. We aim to estimate budget effects of the introduction of a new 1-month LAI, paliperidone palmitate, in Japan. Methods A budget impact analysis was conducted from a payer perspective. The model took direct costs of illness into account (ie, costs for inpatient and outpatient services, as well as drug costs). The robustness of the model was checked using a sensitivity analysis. Results According to our calculations, direct total costs of schizophrenia reach 710,500 million yen a year (US$6 billion). These costs decrease to 691,000 million yen (US$5.9 billion) 3 years after the introduction of paliperidone palmitate. Conclusion From a payer point of view, the introduction of a new treatment for schizophrenia in Japan helps to save resources and is not associated with a higher financial burden.
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Affiliation(s)
- Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan ; Düsseldorf Institute for Competition Economics, University of Düsseldorf, Düsseldorf, Germany
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Ambiguous findings concerning potential advantages of depot antipsychotics: in search of clinical relevance. Curr Opin Psychiatry 2015; 28:216-21. [PMID: 25785710 DOI: 10.1097/yco.0000000000000160] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the recent literature on the comparative efficacy/effectiveness of antipsychotic long-acting injections (LAIs) vs. oral antipsychotics. Randomized controlled trials (RCTs), mirror-image studies and cohort studies are reviewed, and the strength and weaknesses of each design discussed. RECENT FINDINGS The data are conflicting and differ by trial design. RCTs tend to show equivalence for the two treatments, whereas mirror-image studies and cohort studies are more likely to show benefits for LAIs, although a prescribing/channelling bias in cohort studies suggests that LAIs are prescribed to more severely ill patients. Two recent, large RCTs, in a more real-world treatment setting, found a longer time to relapse or treatment failure with a LAI versus oral antipsychotics. SUMMARY Each of the three trial designs has strengths and weaknesses. The traditional RCT does not seem to be the gold standard to compare the effectiveness of oral antipsychotics and LAIs because of selective recruitment and altered ecology of the treatment. Conversely, weaknesses of observational studies include lack of blinding and difficulty disentangling the effect of treatment from prescribing bias and confounders. The best approach to determining comparative effectiveness may be a pragmatic RCT with broad inclusion criteria and minimal exclusion criteria and minimal assessment following baseline assessment and randomization.
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Drake RJ, Nordentoft M, Haddock G, Arango C, Fleischhacker WW, Glenthøj B, Leboyer M, Leucht S, Leweke M, McGuire P, Meyer-Lindenberg A, Rujescu D, Sommer IE, Kahn RS, Lewis SW. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention. Schizophr Bull 2015; 41:584-96. [PMID: 25750247 PMCID: PMC4393703 DOI: 10.1093/schbul/sbv015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate.
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Affiliation(s)
- Richard J Drake
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK;
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen NV, Denmark
| | - Gillian Haddock
- Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK; Manchester Academic Health Sciences Centre, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Marion Leboyer
- INSERM U955, Laboratoire Psychopathologie et génétique des maladies mentales, et AP-HP, DHU Pe-PSY, Pole de Psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris-Est, Créteil, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
| | - Markus Leweke
- Central Institute of Mental Health, Mannheim, Germany
| | | | | | - Dan Rujescu
- Psychiatry, Molecular and Clinical Neurobiology, Ludwig-Maximilians University, München, München, Germany; Department of Psychiatry, University of Halle, Halle, Germany
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Shon W Lewis
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK
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Kuwabara H, Saito Y, Mahlich J. Adherence and rehospitalizations in patients with schizophrenia: evidence from Japanese claims data. Neuropsychiatr Dis Treat 2015; 11:935-40. [PMID: 25897229 PMCID: PMC4389915 DOI: 10.2147/ndt.s81677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze if there is a relationship between adherence to antipsychotic medication and rehospitalization for patients diagnosed with schizophrenia in Japan. METHODS Based on Japanese claims data, we constructed three patient groups based on their medication possession ratio (MPR). Controlling for potential confounders, a Cox proportional hazard model was employed to assess if medication adherence affects the risk of rehospitalization. RESULTS Patients with good adherence (MPRs from 0.8-1.1) had the lowest rates of admission. Both poor adherence (MPRs <0.8) and overadherence (MPRs >1.1) were associated with a significant higher risk of rehospitalization with hazard ratios of 4.7 and 2.0, respectively. CONCLUSION The results of this study support the notion that good adherence to antipsychotic medication reduces the risk of rehospitalization of schizophrenia patients. Appropriate measures should be taken to improve adherence of schizophrenia patients.
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Affiliation(s)
| | | | - Jörg Mahlich
- Health Economics, Janssen KK, Tokyo, Japan ; Düsseldorf Institute for Competition Economics, University of Düsseldorf, Düsseldorf, Germany
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Heres S, Lambert M, Vauth R. Treatment of early episode in patients with schizophrenia: the role of long acting antipsychotics. Eur Psychiatry 2014; 29 Suppl 2:1409-13. [PMID: 25455704 DOI: 10.1016/s0924-9338(14)70001-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022] Open
Abstract
The use of long-acting injectable antipsychotics (LAIs) in schizophrenia is usually restricted to patients in long-term treatment, who prefer them to oral antipsychotics, and to patients with multiple relapses who have a history of non-adherence. However, preliminary evidence from patients in the early phases of the disease suggest that second generation LAIs may be superior to second generation oral medications with regard to the control of negative symptoms and psychosocial functioning. Moreover, several studies have found that psychiatrists are generally reluctant to prescribe LAI antipsychotics and under-estimate their acceptability by patients. Key elements to take into account when offering a LAI in the early course of schizophrenia should include their potential superiority in allowing early detection of non-adherence and in reducing the number of rehospitalisations and relapses.
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Affiliation(s)
- S Heres
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Ismaningerstraße 22, 81675 München, Germany.
| | - M Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - R Vauth
- Psychiatric University Clinics University of Basel, Centre for Mental Health, Kornhausgasse 7, 4051 Basel, Switzerland
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