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Li Q, Li X, Ye C, Jia M, Si T. Characteristics of patients with schizophrenia switching from oral antipsychotics to once-monthly paliperidone palmitate (PP1M): a systematic review. BMC Psychiatry 2024; 24:57. [PMID: 38243208 PMCID: PMC10799459 DOI: 10.1186/s12888-024-05508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The utilization of once-monthly paliperidone palmitate (PP1M) in schizophrenia treatment has increased due to its enhanced adherence and convenience. However, there is limited evidence on patient characteristics that may influence treatment outcomes when switching from oral antipsychotics (OAPs) to PP1M therapy. This systematic review aims to identify such patient characteristics and explore potential beneficial factors to aid healthcare professionals in clinical practice. METHODS A systematic literature search was conducted in the PubMed, Embase, and Cochrane Library databases up to July 19, 2022. Studies related to patients with schizophrenia who had been previously treated with OAPs and switched to PP1M were identified and included. Outcomes included the Positive and Negative Syndrome Scale (PANSS) total score, the clinical Global Impressions - Severity (CGI-S) score, the Personal and Social Performance (PSP) total score, and hospitalisation rate. Data were independently extracted and analysed. The results were presented through a narrative synthesis. RESULTS Eleven studies with a total of 4150 patients were included, identifying nine potential characteristics. The most commonly reported characteristics was patient's prior treatment with OAPs, followed by the stage of disease, duration of illness (DI), ethnicity, reason for switching to PP1M, history of hospitalisation, time of start injection of PP1M, the PANSS and PSP total score at baseline. Patients in the acute stage, with a shorter DI, a less than 1-week time interval to PP1M injection, and a lower PANSS total score at baseline may have a trend on providing better improvements on PANSS total score. Acute stage and shorter DI also showed potential trends in reducing CGI-S score. Early initiation of PP1M, switching for reasons other than lack of efficacy, and a higher PSP score at baseline exhibited potential trends towards better PSP total score improvements. CONCLUSION Our findings may suggest that patients in acute stage, with a shorter duration of illness, with early initiation of PP1M injection, and lower PANSS or PSP scores may trend towards better clinical results when transitioning to PP1M from OAPs. Further research is necessary to validate these potential associations and identify any unexplored characteristics. Such investigations are crucial for providing comprehensive clinical recommendations and informing treatment strategies in this context.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Li Q, Li X, Ye C, Jia M, Si T. Effectiveness and Safety of Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate (PP1M) in the Management of Schizophrenia: A Systematic Review and Meta-Analysis. CNS Drugs 2023; 37:695-713. [PMID: 37490267 PMCID: PMC10439041 DOI: 10.1007/s40263-023-01028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Considering the improvement in adherence and convenience, once-monthly paliperidone palmitate (PP1M) has been increasingly used in the treatment of schizophrenia. However, the outcomes for patients who switch from oral antipsychotics (OAPs) to PP1M have not been reliably assessed. The objective of this systematic review and meta-analysis was to investigate the efficacy and safety of PP1M in the management of patients with schizophrenia with a prior history of OAP use. METHODS We conducted a systematic search in PubMed, EMBASE, and the Cochrane Library on 19 July 2022 to identify eligible studies. All studies that examined the effectiveness and safety of switching from OAPs to PP1M in patients with schizophrenia were included. The primary outcomes were relapse rate, hospitalisation rate, and the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score. The secondary outcomes included the changed number of inpatient visits, changed length of stay hospitalisation, change from baseline in the Clinical Global Impressions-Severity (CGI-S) score and the personal and social performance (PSP) total score, response rate, proportion of treatment discontinuation, and adverse events. We included randomised-controlled trials (RCTs), single-arm studies, and observational studies. Case reports, case series, and reviews were excluded. The quality assessment of included studies was performed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), the 9-point Newcastle-Ottawa Scale (NOS) instrument for non-randomised studies and cohort studies, and the 12-item National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study without control group. Follow-up times were reported as short- (≤ 13 weeks), medium- (14-26 weeks), and long term (≥ 27 weeks). Data were pooled using meta-analysis. RESULTS Fifteen studies with a total of 4740 patients were included. The long-term relapse rates and hospitalisation rates were 12% (95% CI 0.07-0.18) and 18% (95% CI 0.15-0.20), respectively. The short-, medium-, and long-term change in PANSS total score was - 21.69 (95% CI - 30.02 to -13.36), - 14.98 (95% CI - 21.45 to - 8.51) and - 17.88 (95% CI - 31.94 to -3.82), respectively. Approximately 50% of patients reported at least a 30% reduction in the PANSS score at the short-term follow-up. Improvements in CGI-S and PSP score were observed during various periods. There was a reduction in the length of stay hospitalisation and the number of inpatient visits at the medium- and long-term follow-ups. Low discontinuation and adverse event rates were reported. CONCLUSION Based on our findings, this study may support the efficacy and safety of switching from OAPs to PP1M for the treatment of patients with schizophrenia. Future large-scale studies are warranted to confirm our findings.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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The prevalence and independent influencing factors of obesity and underweight in patients with schizophrenia: a multicentre cross-sectional study. Eat Weight Disord 2021; 26:1365-1374. [PMID: 32557379 DOI: 10.1007/s40519-020-00920-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/05/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Few studies have investigated the weight of patients with schizophrenia in China. OBJECTIVE The aim of this study was to analyse the prevalence, clinical characteristics and influencing factors of obesity and underweight in patients with chronic schizophrenia in China. METHODS A total of 325 patients with schizophrenia and 172 sex- and age-matched healthy controls from the community were recruited. Socio-demographic data and laboratory measurements were collected for all subjects. Using the Positive and Negative Syndrome Scale (PANSS), we evaluated the psychiatric symptoms of patients with schizophrenia. According to the body mass index (BMI) criteria in China, BMI ≥ 28 kg/m2 indicates obesity, and BMI < 18.5 kg/m2 indicates underweight. RESULTS Of the patients with schizophrenia, 16.3% were obese, and 6.8% were underweight; 11.0% of the healthy controls were obese, and 3.5% were underweight. There was no difference between the two groups in the prevalence of obesity and underweight. After controlling for relevant variables, the obesity rate remained non significant, but the underweight rate appeared to be different. The multinomial regression analysis revealed that among the patients with schizophrenia, female sex, triglyceride level and LDL level were independent risk factors for obesity and that HDL level was an independent protective factor against obesity. In contrast, male sex and HDL level were independent risk factors for underweight. CONCLUSION We found that the patients with schizophrenia had an increased rate of underweight and some factors related to weight. LEVEL OF EVIDENCE Level V, descriptive study.
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Yang Y, Zhang Y, Wang J, Ning X, Zhang Y, Zhao T, Zhong Y, Liu Z, Xia L, Li W, Yao X, Zhang K, Liu H. Sex Differences in the Association of HOMA-IR Index and BDNF in Han Chinese Patients With Chronic Schizophrenia. Front Psychiatry 2021; 12:656230. [PMID: 34234699 PMCID: PMC8255609 DOI: 10.3389/fpsyt.2021.656230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Previous research has indicated that there are significant sex differences in serum BDNF levels and metabolic indicators in patients with schizophrenia. Studies have found that BDNF is involved in blood sugar regulation. Homeostasis model assessment of insulin resistance (HOMA-IR) is currently a sensitive indicator for measuring insulin resistance. Our study aims to explore the sex differences in the relationship between serum BDNF levels and HOMA-IR in patients with chronic schizophrenia (CS). Methods: A total of 332 patients with CS were enrolled in this study. General information of all participants was collected. Haematological indicators were collected, and the Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychiatric symptoms. Sex differences in serum BDNF levels, HOMA-IR index and other metabolic indexes were investigated. Then, linear regression analysis was used to analyse the relationship between the HOMA-IR index and BDNF levels in male and female patients. Results: The HOMA-IR index of female patients was significantly higher than that of males, but there was no significant difference in serum BDNF levels between male patients and female patients. There was a positive correlation between BDNF level and HOMA-IR index, and this relationship only existed in female patients. Conclusion: The results show that there are significant sex differences in HOMA-IR in patients with CS. In addition, only in female patients was there a positive correlation between the HOMA-IR index and BDNF level, which suggests that sex factors should be taken into account in evaluating the relationship between BDNF and blood glucose in patients with CS.
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Affiliation(s)
- Yating Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Juan Wang
- Chengdu Fourth People's Hospital, Chengdu, China
| | - Xiaoshuai Ning
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Yelei Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Tongtong Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Yi Zhong
- Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Zhiwei Liu
- Fuyang Third People's Hospital, Fuyang, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Wenzheng Li
- Hefei Fourth People's Hospital, Hefei, China
| | - Xianhu Yao
- Ma'anshan Fourth People's Hospital, Ma'anshan, China
| | - Kai Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Chaohu, China.,Anhui Psychiatric Center, Anhui Medical University, Chaohu, China
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Wang J, Zhang Y, Liu Z, Yang Y, Zhong Y, Ning X, Zhang Y, Zhao T, Xia L, Geng F, Tao R, Fan M, Ren Z, Liu H. Schizophrenia patients with a metabolically abnormal obese phenotype have milder negative symptoms. BMC Psychiatry 2020; 20:410. [PMID: 32811450 PMCID: PMC7437037 DOI: 10.1186/s12888-020-02809-4] [Citation(s) in RCA: 6] [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: 01/21/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Schizophrenia patients with a metabolically abnormal obese (MAO) phenotype have been shown poor cardiovascular outcomes, but the characteristics of their current psychiatric symptoms have not been characterized. This study mainly explored the psychiatric symptoms of schizophrenia patients with the MAO phenotype. METHODS A total of 329 patients with schizophrenia and 175 sex- and age-matched people without schizophrenia from Anhui Province in China were enrolled. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate the mental symptoms of the schizophrenia patients. The MAO phenotype was defined as meeting 1-4 metabolic syndrome criteria (excluding waist circumference) and having a body mass index (BMI) ≥ 28 kg/m2. And, metabolically healthy normal-weight (MHNW) phenotype was defined as meeting 0 criteria for metabolic syndrome and 18.5 ≤ BMI < 24 kg/m2. RESULTS Overall, 15.8% of the schizophrenia patients and 9.1% of the control group were consistent with the MAO phenotype, and the prevalence of MAO in the schizophrenia group was higher than that in the control group. Among the patients with schizophrenia, the MAO group had lower negative factor, cognitive factor and total PANSS scores than the MHNW group. However, when confounding factors were controlled, only the negative factor remained lower significantly. CONCLUSION We found that schizophrenia patients with the MAO phenotype had reduced negative symptoms, which may indicate an internal mechanism linking metabolic disorders and negative symptoms. TRIAL REGISTRATION This study was registered in the China Clinical Trial Registration Center (No. chiCTR 1,800,017,044 ).
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Affiliation(s)
- Juan Wang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yulong Zhang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Zhiwei Liu
- Department of psychiatry, Fuyang Third People’s Hospital, Anhui, China
| | - Yating Yang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yi Zhong
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoshuai Ning
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yelei Zhang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Tongtong Zhao
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lei Xia
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People’s Hospital, Hefei, China
| | - Rui Tao
- Department of Psychiatry, Hefei Fourth People’s Hospital, Hefei, China
| | - Mei Fan
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Zhenhua Ren
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230000, China.
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, China. .,Anhui Psychiatric Center, Anhui Medical University, Hefei, China.
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Li K, Liao Y, Yang Z, Yang C, Chen M, Wu X, Gan Z. Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance. Front Psychiatry 2020; 11:529672. [PMID: 33488408 PMCID: PMC7819884 DOI: 10.3389/fpsyt.2020.529672] [Citation(s) in RCA: 1] [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] [Received: 01/26/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI). Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression-Bipolar Disorder-Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up. Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected. Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.
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Affiliation(s)
- Kanglai Li
- Very Important Patients Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingtao Liao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhihua Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Caishuang Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhua Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiuhua Wu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Chang CH, Lane HY, Liu CY, Chen SJ, Lin CH. Paliperidone is associated with reduced risk of severe hepatic outcome in patients with schizophrenia and viral hepatitis: A nationwide population-based cohort study. Psychiatry Res 2019; 281:112597. [PMID: 31629300 DOI: 10.1016/j.psychres.2019.112597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Paliperidone, a second-generation antipsychotic, has been found to have minimal hepatotoxicity in patients with schizophrenia. However, long-term hepatic outcome in patients with schizophrenia and viral hepatitis remains unclear. METHODS Data obtained from the Taiwan National Health Insurance Research Database was used to enroll newly diagnosed schizophrenic patients between January 2007 and December 2013. Patients with schizophrenia and viral hepatitis who were receiving paliperidone were allocated to the paliperidone group while those who were not receiving paliperidone were allocated to the control group. Using a 1:2 ratio, we matched the age, sex, and index year to select the control participants. Patients with severe hepatic outcomes (SHOs) before enrollment were excluded. The two groups were studied until December 31, 2013. The primary endpoint was the occurrence of SHOs including liver failure, liver decompensation, liver transplantation, or liver cancer. RESULTS We identified 134 patients with schizophrenia and viral hepatitis who received paliperidone and 268 matched patients who did not receive paliperidone. Of the 402 patients, 22 (5.47%) developed SHOs during a mean follow-up period of 3.57 ± 1.62 years, including 2 (1.49%) from the paliperidone cohort and 20 (7.46%) from the control group. Furthermore, the Cox multivariate proportional hazards analysis revealed that the risk decreased with paliperidone use (adjusted hazard ratio [HR]: 0.155, 95% confidence interval [CI]: 0.032-0.737, p = 0.019) after adjusted for confounding factors. CONCLUSION Paliperidone treatment was associated with a reduced risk of SHOs in patients with schizophrenia and viral hepatitis.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab,Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No 123, Dapi Rd, Niaosong District, Kaohsiung 833, Taiwan.
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Choon JWY, Wu DBC, Chong HY, Lo WTL, Chong CSY, Chung WS, Chui EMC, Tomlinson B, Lee VWY, Lee SC, Lee KKC. Real-world evidence of improved healthcare utilization in patients with schizophrenia or schizoaffective disorder after early treatment of paliperidone palmitate once-monthly treatment in Hong Kong. J Med Econ 2019; 22:273-279. [PMID: 30561238 DOI: 10.1080/13696998.2018.1560749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Very few data are available to demonstrate the economic benefit of early paliperidone palmitate once-monthly long-acting injectable (PP1M) treatment in patients with schizophrenia or schizoaffective disorder. METHODS AND MATERIALS This study has retrospectively compared the healthcare utilization and associated costs of pre- and post-PPIM treatment in 413 patients with schizophrenia or schizoaffective disorder recruited from three major public hospitals providing psychiatric services in Hong Kong. Patients were categorized into early treatment (≤3 years since diagnosis) and chronic (>3 years) groups, and also whether they were receiving polypharmacy (POP). RESULTS It was found that patients who were started on early therapy with no POP had the most favourable outcomes. Overall results of the entire cohort, including both early and late treatments, indicate that there was a slight increase in annual in-patient days (IP) per patient and outpatient visit (OP) by 3.18 and 1.87, respectively, and a decrease in emergency room visit (ER) of 0.9 (p < 0.05). For non-polypharmacy (NP) patients receiving early PP1M therapy, there was a significant decrease in IP and ER of 21.56 (p < 0.05) and 1.15 (p < 0.05), respectively, but an increase in OP of 1.88 (p < 0.05). For patients with POP, there was an all-across increase in IP and all-across decrease in OP and ER. In monetary terms, a NP patient receiving early therapy may have an overall saving of HKD40,878 (USD5,241, 1USD = 7.8HKD) per year compared to HKD6,224 (USD798) in patients where therapy was given after 3 years. For patients with POP, there was an all-across increase in overall spending despite reductions in OP and ER. CONCLUSIONS From the 413 patients studied, potential annual savings is higher by early administration of PPIM in patients with NP. Analysis using multivariate linear regression based on generalized estimating equations and sensitivity analysis using a linear mixed model supported the findings.
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Affiliation(s)
- June W Y Choon
- a School of Pharmacy , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | - David B C Wu
- a School of Pharmacy , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
- b Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | - H Y Chong
- a School of Pharmacy , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | | | | | - W S Chung
- d Tai Po Hospital , Hong Kong , PR China
| | | | | | - Vivian W Y Lee
- g School of Pharmacy , the Chinese University of Hong Kong , Hong Kong , PR China
| | - S C Lee
- f Prince of Wales Hospital , Hong Kong , PR China
| | - Kenneth K C Lee
- a School of Pharmacy , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
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9
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Lange-Asschenfeldt C. [Psychiatric pharmacotherapy of older individuals with severe mental illness]. Z Gerontol Geriatr 2018; 51:770-778. [PMID: 30302537 DOI: 10.1007/s00391-018-1455-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic schizophrenia, depression, and bipolar disorders, among other chronic psychiatric disorders with onset at youth or early adulthood are often referred to as severe mental illness (SMI). Aging with SMI is associated with various psychosocial, physiological, and medical problems with potential impact on psychiatric pharmacotherapy. OBJECTIVES Determination and discussion of problems and special features of the psychopharmacological treatment of older persons with SMI and presentation of treatment recommendations for the distinct diagnoses. MATERIALS AND METHODS International literature and guidelines were searched. In addition, the basic literature and expert opinions are discussed. RESULTS General problems that influence the psychiatric pharmacotherapy of older persons with SMI include nonadherence, nonresponse, polypharmacy, and distinct pharmacokinetic changes with aging and somatic comorbidity. Psychotropic drugs may exhibit cardiovascular, metabolic, and neuropsychiatric risks, among others. The literature regarding effectiveness of psychotropic drugs, drug groups, or combination of drugs in older patients with SMI is scarce to nonexistent. CONCLUSIONS Drug treatment of older persons with SMI should be part of an overall treatment plan that also has to include social and psychotherapeutic components that address the specific problems of this population. Most importantly, psychiatric pharmacotherapy should consider these risks and the treatment should be tailored to a patient's individual risk profile. Due to a general lack of evidence in this special population, treatment strategies of standard guidelines should be adjusted with special consideration to physiological changes of age.
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Affiliation(s)
- Christian Lange-Asschenfeldt
- Abteilung Gerontopsychiatrie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland.
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