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Vita G, Tavella A, Ostuzzi G, Tedeschi F, De Prisco M, Segarra R, Solmi M, Barbui C, Correll CU. Efficacy and safety of long-acting injectable versus oral antipsychotics in the treatment of patients with early-phase schizophrenia-spectrum disorders: a systematic review and meta-analysis. Ther Adv Psychopharmacol 2024; 14:20451253241257062. [PMID: 38831918 PMCID: PMC11145998 DOI: 10.1177/20451253241257062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Background Long-acting injectable antipsychotics (LAIs) have advantages over oral antipsychotics (OAPs) in preventing relapse and hospitalization in chronically ill patients with schizophrenia-spectrum disorders (SSDs), but evidence in patients with first-episode/recent-onset, that is, early-phase-SSDs is less clear. Objectives To assess the relative medium- and long-term efficacy and safety of LAIs versus OAPs in the maintenance treatment of patients with early-phase SSDs. Method We searched major electronic databases for head-to-head randomized controlled trials (RCTs) comparing LAIs and OAPs for the maintenance treatment of patients with early-phase-SSDs. Design Pairwise, random-effects meta-analysis. Relapse/hospitalization and acceptability (all-cause discontinuation) measured at study-endpoint were co-primary outcomes, calculating risk ratios (RRs) with their 95% confidence intervals (CIs). Subgroup analyses sought to identify factors moderating differences in efficacy or acceptability between LAIs and OAPs. Results Across 11 head-to-head RCTs (n = 2374, median age = 25.2 years, males = 68.4%, median illness duration = 45.8 weeks) lasting 13-104 (median = 78) weeks, no significant differences emerged between LAIs and OAPs for relapse/hospitalization prevention (RR = 0.79, 95%CI = 0.58-1.06, p = 0.13) and acceptability (RR = 0.92, 95%CI = 0.80-1.05, p = 0.20). The included trials were highly heterogeneous regarding methodology and patient populations. LAIs outperformed OAPs in preventing relapse/hospitalization in studies with stable patients (RR = 0.65, 95%CI = 0.45-0.92), pragmatic design (RR = 0.67, 95%CI = 0.54-0.82), and strict intent-to-treat approach (RR = 0.64, 95%CI = 0.52-0.80). Furthermore, LAIs were associated with better acceptability in studies with schizophrenia patients only (RR = 0.87, 95%CI = 0.79-0.95), longer illness duration (RR = 0.88, 95%CI = 0.80-0.97), unstable patients (RR = 0.89, 95%CI = 0.81-0.99) and allowed OAP supplementation of LAIs (RR = 0.90, 95%CI = 0.81-0.99). Conclusion LAIs and OAPs did not differ significantly regarding relapse prevention/hospitalization and acceptability. However, in nine subgroup analyses, LAIs were superior to OAPs in patients with EP-SSDs with indicators of higher quality and/or pragmatic design regarding relapse/hospitalization prevention (four subgroup analyses) and/or reduced all-cause discontinuation (five subgroup analyses), without any instance of OAP superiority versus LAIs. More high-quality pragmatic trials comparing LAIs with OAPs in EP-SSDs are needed. Trial registration CRD42023407120 (PROSPERO).
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Affiliation(s)
- Giovanni Vita
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Angelantonio Tavella
- Department of Translational Biomedicine and Neuroscience, University of Bari ’Aldo Moro’, Bari, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Segarra
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Bilbao, Spain
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, ON, Canada
- SCIENCES Lab, Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Christoph U. Correll
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
- The Zucker Hillside Hospital, Department of Psychiatry, 75-59 263rd Street, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Northwell Health, New Hyde Park, NY, USA
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
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2
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Finocchio B, Hilliard W. Therapeutic Outcomes of Treatment With Long-Acting Injectable Antipsychotics in Forensic Populations With Schizophrenia-Spectrum Diagnoses. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:71-81. [PMID: 38442318 DOI: 10.1089/jchc.23.10.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The advantages of long-acting injectable antipsychotics (LAIs) in schizophrenia are well studied. However, forensic involvement is common in schizophrenia, and incarcerated individuals are often excluded from clinical trials. Nonadherence and oral medication diversion in forensic populations with schizophrenia, and the relationship between antipsychotic nonadherence and crime support LAI utilization in this subset of patients. Yet, federal regulations limit data generation in forensic populations. This review characterizes data on therapeutic outcomes of LAIs in correctional populations with schizophrenia-spectrum diagnoses. A search for primary literature was conducted in PubMed. Favorable effects of LAIs were observed on adherence, psychiatric symptomatology, patient satisfaction, health care costs, and frequency of criminal charges. Data were primarily retrospective and included small samples and individuals with historical versus current forensic involvement. Although limited, available literature and insights into the correctional system suggest advantages to LAI use in forensic populations. Barriers to conducting research in correctional settings must be addressed to facilitate further data generation.
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Affiliation(s)
| | - Wanda Hilliard
- Texas Tech University Health Science Center, Lubbock, Texas, USA
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Lian L, Kim DD, Procyshyn RM, Fredrikson DH, Cázares D, Honer WG, Barr AM. Efficacy of long-acting injectable versus oral antipsychotic drugs in early psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2022; 16:589-599. [PMID: 34263540 DOI: 10.1111/eip.13202] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/07/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
AIM Long-acting injectable antipsychotic drugs (LAIs) are often used as an alternative to oral antipsychotics (OAPs) in individuals with psychosis who demonstrate poor medication adherence. Previous meta-analyses have found mixed results on the efficacy of LAIs, compared to OAPs, in patients with psychotic disorders. The objective of this meta-analysis was to compare the effectiveness of using LAIs versus OAPs in the early stages of psychosis. METHODS Major electronic databases were used to search for any studies examining the comparative effectiveness (i.e., relapse, adherence, hospitalization, and all-cause discontinuation) of any LAIs versus OAPs in early stages of psychosis. Studies published up to 6 June, 2019 were included and no language restriction was applied. Inclusion criteria were a diagnosis of schizophrenia or related disorder, where patients were in their first episode or had a duration of illness ≤5 years. Data were analysed using a random-effects model. RESULTS Fifteen studies (n = 10 584) were included, of which were 7 RCTs, 7 observational studies, and 1 post-hoc analysis. We found that LAIs provided advantages over OAPs in terms of relapse rates. No significant differences were found between LAI and OAP groups in terms of all-cause discontinuation, hospitalization, and adherence rates. However, considering only RCTs revealed advantages of LAIs over OAPs in terms of hospitalization rates. CONCLUSIONS LAIs may provide benefits over OAPs with respect to reducing relapse and hospitalization rates in early psychosis patients. There is a need for larger and better-designed studies comparing OAPs and LAIs specifically in early psychosis patients.
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Affiliation(s)
- Lulu Lian
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane H Fredrikson
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana Cázares
- Department of Chemical & Biological Sciences, Universidad de las Americas Puebla, Puebla, Mexico
| | - William G Honer
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada
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4
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Lian L, Kim DD, Procyshyn RM, Cázares D, Honer WG, Barr AM. Long-acting injectable antipsychotics for early psychosis: A comprehensive systematic review. PLoS One 2022; 17:e0267808. [PMID: 35486616 PMCID: PMC9053823 DOI: 10.1371/journal.pone.0267808] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
AIM Long acting injectable (LAI) antipsychotics are an alternative to oral antipsychotic (OAP) treatment and may be beneficial for patients in the early stages of schizophrenia. This study aims to provide a comprehensive review on the efficacy of first-generation and second-generation LAI antipsychotics in recent-onset, first-episode, and early psychosis patients. METHODS MEDLINE, EMBASE, PsycINFO, and Web of Science Core databases were used to search for studies that used LAIs in early psychosis patients. Studies published up to 06 Jun 2019 were included with no language restrictions applied. Inclusion criteria were a diagnosis of schizophrenia or related disorder, where patients were in their first episode or had a duration of illness ≤5 years. RESULTS 33 studies were included: 8 RCTs, 4 post-hoc analyses, 2 case reports, and 19 naturalistic studies. The majority of studies evaluated risperidone LAIs (N = 14) and paliperidone palmitate (N = 10), while the remainder investigated fluphenazine decanoate (N = 3), flupentixol decanoate (N = 2), and aripiprazole (N = 1). Two studies did not specify the LAI formulation used, and one cohort study compared the efficacy of multiple different LAI formulations. CONCLUSIONS While the majority of data is based on naturalistic studies investigating risperidone LAIs or paliperidone palmitate, LAIs may be an effective treatment for early psychosis patients in terms of adherence, relapse reduction, and symptom improvements. There is still a need to conduct more high quality RCTs that investigate the efficacy of different LAI formulations in early psychosis patients.
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Affiliation(s)
- Lulu Lian
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, B.C., Canada
| | - David D. Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, B.C., Canada
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, B.C., Canada
| | - Ric M. Procyshyn
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, B.C., Canada
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada
| | - Diana Cázares
- Department of Chemical & Biological Sciences, Universidad de las Americas Puebla, Puebla, Mexico
| | - William G. Honer
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, B.C., Canada
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, B.C., Canada
- British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, B.C., Canada
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5
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Oyelade OO, Nkosi-Mafutha NG. Psychosocial rehabilitation of individuals with schizophrenia: a scoping review protocol. Syst Rev 2022; 11:32. [PMID: 35183253 PMCID: PMC8858536 DOI: 10.1186/s13643-022-01901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The psychosocial rehabilitation of an individual with mental illness is an evidence-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising scope for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map studies on how psychosocial rehabilitation is conducted for people living in Africa with the most chronic form of mental illness, schizophrenia. METHODS This study will adopt the Arksey and O'Malley scoping review framework to search and compile relevant studies. This process will involve three steps: title screening, to be performed solely by the principal investigator, followed by abstract and full-text screening, to be performed independently by two reviewers (the principal investigator and co-investigator). Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records, and data charting form will be used to extract basic data of included studies. The risk of bias in the articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT). Finally, the content analysis of the screened studies will be performed with NVivo. EXPECTED OUTCOME This study has the likelihood of revealing a research gap in psychosocial rehabilitation approaches and methods. The review results will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the psychosocial rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Sahara Africa. The implementation process also encompasses disseminating the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.
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Affiliation(s)
- Oyeyemi Olajumoke Oyelade
- Department of Nursing Education, School of Therapeutic Sciences, University of the Witwatersrand, Park Town, Johannesburg, South Africa.
- Department of Nursing Science, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun-State, Nigeria.
| | - Nokuthula Gloria Nkosi-Mafutha
- Department of Nursing Education, School of Therapeutic Sciences, University of the Witwatersrand, Park Town, Johannesburg, South Africa
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6
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Corbo M, Martinotti G, Aguglia A, Salvi V, Amerio A, Calò S, Fusar-Poli L, Serafini G, Signorelli M, Amore M, Mencacci C, Di Sciascio G, Biggio G, Aguglia E, Di Giannantonio M. Long-acting second-generation and oral antipsychotics for substance use disorders and psychotic symptoms: Prescribing attitudes among Italian psychiatrists. Perspect Psychiatr Care 2021; 57:1700-1706. [PMID: 33616260 DOI: 10.1111/ppc.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To explore Italian psychiatrists' attitudes toward the off-label use of second generation antipsychotics (SGAs) in patients with substance use disorder and psychotic symptoms. DESIGN AND METHODS A sample of 300 Italian psychiatrists associated with the Italian Society of Neuropsychopharmacology was randomly selected to complete a survey about the off-label prescription of SGAs. FINDINGS Oral aripiprazole (32.7%), olanzapine (30.2%), and quetiapine (25.2%) were considered "appropriate." Long-acting antipsychoticss were generally considered "inappropriate." PRACTICE IMPLICATIONS Our findings reflect a substantial level of uncertainty and a lack of coherent clinical guidance within the realm of dual diagnosis treatment. Therefore, they emphasize the need to develop specific guidelines to improve the management of pharmacotherapy among this population.
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Affiliation(s)
- Mariangela Corbo
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy.,Department of Pharmacy, Pharmacology and Clinical Science, University of Hertfordshire, Herts, UK
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Calò
- Department of Mental Health, Local Health Agency, Lecce, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Signorelli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy
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7
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Minwalla HD, Wrzesinski P, Desforges A, Caskey J, Wagner B, Ingraffia P, Patterson JC, Edinoff AN, Kaye AM, Kaye AD, Viswanath O, Urits I. Paliperidone to Treat Psychotic Disorders. Neurol Int 2021; 13:343-358. [PMID: 34449689 PMCID: PMC8396046 DOI: 10.3390/neurolint13030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the literature regarding the use of paliperidone in the treatment of schizophrenia and schizoaffective disorder. It covers the background and presentation of schizophrenia and schizoaffective disorder, as well as the mechanism of action and drug information for paliperidone. It covers the existing evidence of the use of paliperidone for the treatment of schizophrenia and schizoaffective disorder. RECENT FINDINGS Schizophrenia and schizoaffective disorder lead to significant cognitive impairment. It is thought that dopamine dysregulation is the culprit for the positive symptoms of schizophrenia and schizoaffective disorder. Similar to other second-generation antipsychotics, paliperidone has affinity for dopamine D2 and serotonin 5-HT2A receptors. Paliperidone was granted approval in the United States in 2006 to be used in the treatment of schizophrenia and in 2009 for schizoaffective disorder. SUMMARY Schizophrenia and schizoaffective disorder have a large impact on cognitive impairment, positive symptoms and negative symptoms. Patients with either of these mental illnesses suffer from impairments in everyday life. Paliperidone has been shown to reduce symptoms of schizophrenia and schizoaffective disorder.
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Affiliation(s)
- Hormazd D. Minwalla
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103, USA; (P.W.); (J.C.P.II); (A.N.E.)
- Correspondence: ; Tel.: +1-318-675-6619
| | - Peter Wrzesinski
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103, USA; (P.W.); (J.C.P.II); (A.N.E.)
| | - Allison Desforges
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (A.D.); (J.C.); (B.W.); (P.I.)
| | - Joshua Caskey
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (A.D.); (J.C.); (B.W.); (P.I.)
| | - Brittany Wagner
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (A.D.); (J.C.); (B.W.); (P.I.)
| | - Patrick Ingraffia
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (A.D.); (J.C.); (B.W.); (P.I.)
| | - James C. Patterson
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103, USA; (P.W.); (J.C.P.II); (A.N.E.)
| | - Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103, USA; (P.W.); (J.C.P.II); (A.N.E.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- College of Medicine, Phoenix Campus, University of Arizona, Phoenix, AZ 84006, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68124, USA
- Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ 84006, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University, Shreveport, LA 71103, USA; (A.D.K.); (O.V.); (I.U.)
- Southcoast Physicians Group Pain Medicine, Southcoast Health, Wareham, MA 02720, USA
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8
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Bhatta MP, Bista S, El Khoury AC, Hutzell EG, Tandon N, Smith D. Long-Acting Injectable Antipsychotic Use in Patients with Schizophrenia and Criminal Justice System Encounters. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:63-70. [PMID: 34056030 PMCID: PMC8137150 DOI: 10.36469/jheor.2021.22979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Background: Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, thus increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses. Objective: To assess the association between long-acting injectable (LAI) antipsychotic use and criminal justice system encounters in patients with schizophrenia or schizoaffective disorder. Methods: This retrospective follow-up study was conducted among patients aged ≥18 years treated for schizophrenia or schizoaffective disorder at a community mental health center in Akron, Ohio, between January 1, 2010, and June 15, 2016. The incidence of criminal justice system encounters at 6 months, 1 year, and 2 years pre- versus post-LAI antipsychotic initiation was assessed. A subanalysis was conducted for individuals with a history of prior arrest. Results: Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with LAI antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59-0.93]; P<0.01) and 2 years (0.74 [0.62-0.88]; P<0.0001). Statistically significant reductions in criminal justice system encounters after treatment than before treatment were observed in the once-monthly paliperidone palmitate (PP1M) cohort. The incidence of arrests was lower in the 6-month (27 vs 85 arrests), 1-year (46 vs 132 arrests) and 2-year (88 vs 196 arrests) periods post-index LAI medication than in the corresponding periods pre-index LAI medication among individuals with a history of prior arrest. Conclusions: Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, specifically PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment.
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Affiliation(s)
| | - Saroj Bista
- Kent State University College of Public Health, Kent, OH
| | | | - Eric G. Hutzell
- County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Akron, OH
| | | | - Douglas Smith
- County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Akron, OH
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9
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Oyelade OO, Nkosi‐Mafutha NG. Living beyond the limitation: Rehabilitation, life and productivity of individuals with schizophrenia in South-West Nigeria. Health Expect 2021; 24:198-208. [PMID: 33428815 PMCID: PMC8077146 DOI: 10.1111/hex.13139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Schizophrenia, the most chronic and stigmatized form of mental illness, can be described as a brain disorder that affects an individual's cognition. Individuals with schizophrenia exhibit socially unacceptable symptoms that affect their psychosocial lives. They suffer from reduced productivity due to the debilitating effect of the illness, and the negative symptoms impede their employability; such symptoms and effects aggravate the stigma around mental illness. However, when rehabilitation is successfully achieved, so is productivity, and this decreases the associated stigma. Thus, this study describes the rehabilitation experiences and productivity of individuals with schizophrenia in South-West Nigeria. METHODS AND ANALYSIS A descriptive qualitative approach with semi-structured interviews was used to gather information from mental health service users. The discharged users in this study received in-hospital or outpatient rehabilitation care at four outpatient units within two specialist mental health-care facilities in South-West Nigeria. These facilities offer vocational training and rehabilitation services for individuals with schizophrenia. Twenty-nine mental health service users were interviewed. The data from the interviews were independently analysed by two researchers through a content analysis approach using NVIVO version 11. The researchers compared the results of the analysis and reached an agreement on the conclusion. FINDINGS AND RECOMMENDATIONS The rehabilitation services availed by patients in the research setting are of three types. Some attend occupational rehabilitation to learn a trade; they depend on professionals for the choice of skill but at a cost that is not affordable to many. Some stay in rehabilitation units linked to the hospital, rendering their services at a cost, and their living expenses and skill acquisition processes are based on the remuneration they get from the services rendered to the institution. Others depend on their family members' efforts to afford rehabilitation services but set up on job by family or employed in family business. The mental health service users in this study who offered their services to the institutions were able to make informed decisions and showed better performance with their chosen occupation than those who depended on their family or health professionals for the choice of rehabilitation service or vocational career. Therefore, this study concludes that prioritizing mental health facility users' preferences in terms of productive activities (sales, services, vocation) or rehabilitation goals should be encouraged.
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Affiliation(s)
- Oyeyemi Olajumoke Oyelade
- Department of Nursing EducationSchool of Therapeutic SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
- Department of Nursing Science, Faculty of Basic Medical SciencesObafemi Awolowo UniversityIle-IfeOsun-stateNigeria
| | - Nokuthula Gloria Nkosi‐Mafutha
- Department of Nursing EducationSchool of Therapeutic SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
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10
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Brown B, Turkoz I, Mancevski B, Mathews M. Evaluation of paliperidone palmitate long-acting injectable antipsychotic therapy as an early treatment option in patients with schizophrenia. Early Interv Psychiatry 2020; 14:428-438. [PMID: 31515972 PMCID: PMC7384107 DOI: 10.1111/eip.12868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/19/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023]
Abstract
AIM This exploratory post hoc analysis of a randomized, double-blind (DB), multicentre, non-inferiority study (NCT01515423) evaluated the effects of the long-acting injectable antipsychotic therapies once-monthly paliperidone palmitate (PP1M) and once-every-3-months paliperidone palmitate (PP3M) on symptom severity and functional remission in patients with schizophrenia with differing durations of illness (≤5, 6-10 and >10 years). METHODS Endpoints included Personal and Social Performance (PSP) scale and Positive and Negative Syndrome Scale (PANSS) total scores during the DB phase (DB baseline and DB endpoint) and the proportion of patients meeting PSP or PANSS remission criteria at any time during the open-label (OL) or DB phases that were maintained for ≥3, ≥6, ≥9 or ≥12 months. RESULTS In both the OL and DB phases, significant improvements in PSP scale and PANSS scores were observed from baseline in all duration-of-illness groups, with significantly greater improvements observed in the ≤5-year and 6-10-year groups compared with the >10-year group. The proportion of patients who maintained PSP or PANSS remission criteria for ≥3, ≥6, ≥9 and ≥12 months was higher in the ≤5-year and 6-10-year groups than in the >10-year group. Safety profiles were similar across duration-of-illness groups in the DB phase. CONCLUSIONS Symptomatic and functional improvements were observed with PP1M/PP3M in patients with differing durations of schizophrenia, but the magnitude of the effects was greater in those with early illness vs chronic illness. These findings advocate implementation of PP1M and PP3M in all stages of schizophrenia, including early illness.
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Affiliation(s)
- Brianne Brown
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, Titusville, New Jersey
| | | | - Maju Mathews
- Janssen Research and Development, LLC, Titusville, New Jersey
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11
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Peters L, Krogmann A, von Hardenberg L, Bödeker K, Nöhles VB, Correll CU. Long-Acting Injections in Schizophrenia: a 3-Year Update on Randomized Controlled Trials Published January 2016-March 2019. Curr Psychiatry Rep 2019; 21:124. [PMID: 31745659 DOI: 10.1007/s11920-019-1114-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This study was conducted in order to review randomized controlled trial (RCT) data published January 2016-March 2019 on long-acting injectable antipsychotics (LAIs) for schizophrenia. RECENT FINDINGS Thirty-one RCTs (primary studies = 7; post hoc analyses = 24; n = 4738) compared LAIs vs. placebo (studies = 11, n = 1875), LAIs vs. oral antipsychotics (OAPs) (studies = 7, n = 658), and LAI vs. LAI (studies = 13, n = 2205). LAIs included two new formulations, aripiprazole lauroxil nanocrystal dispersion and subcutaneously injectable risperidone Perseris, as well as aripiprazole lauroxil, aripiprazole once-monthly, paliperidone once-monthly, paliperidone 3-monthly, and risperidone-LAI. Regarding prevention of relapse and hospitalization, LAIs consistently outperformed placebo, being partly superior to OAPs, without relevant LAI-LAI differences. LAIs were comparable to OAPs regarding all-cause discontinuation, functioning, quality of life, and tolerability, being associated with higher patient satisfaction and service engagement. Recent meta-analyses yielded mixed results, but never favoring OAPs over LAIs. In RCTs, LAIs are superior to placebo, but only in some aspects, superior to OAPs. Comparative effectiveness of LAIs vs. OAPs requires further study, ideally in generalizable/real-world samples.
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Affiliation(s)
- Luisa Peters
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Amanda Krogmann
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Laura von Hardenberg
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Bödeker
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, USA. .,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Bell Lynum KS, Turkoz I, Kim E. Paliperidone palmitate once-every-3-months in adults with early illness schizophrenia. Early Interv Psychiatry 2019; 13:667-672. [PMID: 29968279 PMCID: PMC6585630 DOI: 10.1111/eip.12685] [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: 11/22/2017] [Revised: 03/05/2018] [Accepted: 05/16/2018] [Indexed: 11/08/2022]
Abstract
AIM This post hoc analysis of a double-blind (DB), randomized, placebo-controlled, relapse-prevention study evaluated the effects of paliperidone palmitate once-every-3-months (PP3M) in a subpopulation of adults with early illness schizophrenia (duration ≤5 years) from a clinical trial. METHODS Patients received either PP3M or placebo every 3 months in the DB phase. The primary efficacy variable was time from randomization to first relapse. Symptom severity, patient functioning, and safety were also assessed. RESULTS A total of 119 patients who entered the DB phase met the criteria for early illness schizophrenia (PP3M, n = 62; placebo, n = 57). PP3M significantly delayed time to relapse vs placebo (P = .035; hazard ratio, 3.08; 95% CI, 1.08-8.80). Symptomatic control and patient functioning were maintained in the PP3M group but significantly worsened in the placebo group. There were no unexpected tolerability findings. CONCLUSIONS PP3M reduced relapse risk and maintained symptomatic and functional improvements compared with placebo in patients with early illness schizophrenia.
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Affiliation(s)
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
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13
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Newton R, Rouleau A, Nylander AG, Loze JY, Resemann HK, Steeves S, Crespo-Facorro B. Diverse definitions of the early course of schizophrenia-a targeted literature review. NPJ SCHIZOPHRENIA 2018; 4:21. [PMID: 30323274 PMCID: PMC6189105 DOI: 10.1038/s41537-018-0063-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a debilitating psychiatric disorder and patients experience significant comorbidity, especially cognitive and psychosocial deficits, already at the onset of disease. Previous research suggests that treatment during the earlier stages of disease reduces disease burden, and that a longer time of untreated psychosis has a negative impact on treatment outcomes. A targeted literature review was conducted to gain insight into the definitions currently used to describe patients with a recent diagnosis of schizophrenia in the early course of disease ('early' schizophrenia). A total of 483 relevant English-language publications of clinical guidelines and studies were identified for inclusion after searches of MEDLINE, MEDLINE In-Process, relevant clinical trial databases and Google for records published between January 2005 and October 2015. The extracted data revealed a wide variety of terminology and definitions used to describe patients with 'early' or 'recent-onset' schizophrenia, with no apparent consensus. The most commonly used criteria to define patients with early schizophrenia included experience of their first episode of schizophrenia or disease duration of less than 1, 2 or 5 years. These varied definitions likely result in substantial disparities of patient populations between studies and variable population heterogeneity. Better agreement on the definition of early schizophrenia could aid interpretation and comparison of studies in this patient population and consensus on definitions should allow for better identification and management of schizophrenia patients in the early course of their disease.
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Affiliation(s)
- Richard Newton
- Austin Health, University of Melbourne, Melbourne, VIC, Australia.,Peninsula Health, Frankston, VIC, Australia
| | | | | | | | | | | | - Benedicto Crespo-Facorro
- Department of Medicine & Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain
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Howells FM, Kingdon DG, Baldwin DS. Current and potential pharmacological and psychosocial interventions for anxiety symptoms and disorders in patients with schizophrenia: structured review. Hum Psychopharmacol 2017; 32. [PMID: 28812313 DOI: 10.1002/hup.2628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Between 30% and 62% of patients with schizophrenia present with co-morbid anxiety disorders that are associated with increased overall burden. Our aim was to summarize current and potential interventions for anxiety in schizophrenia. DESIGN Structured review, summarizing pharmacological and psychosocial interventions used to reduce anxiety in schizophrenia and psychosis. RESULTS Antipsychotics have been shown to reduce anxiety, increase anxiety, or have no effect. These may be augmented with another antipsychotic, anxiolytic, or antidepressant. Novel agents, such as L-theanine, pregabalin, and cycloserine, show promise in attenuating anxiety in schizophrenia. Psychosocial therapies have been developed to reduce the distress of schizophrenia. Cognitive behavioural therapy (CBT) has shown that benefit and refinements in the therapy have been successful, for example, for managing worry in schizophrenia. CBT usually involves more than 16 sessions, as short courses of CBT do not attenuate the presentation of anxiety in schizophrenia. To address time and cost, the development of manualized CBT to address anxiety in schizophrenia is being developed. CONCLUSIONS The presence of coexisting anxiety symptoms and co-morbid anxiety disorders should be ascertained when assessing patients with schizophrenia or other psychoses as a range of pharmacological and psychosocial treatments are available.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - David G Kingdon
- Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
| | - David S Baldwin
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
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Pilon D, Muser E, Lefebvre P, Kamstra R, Emond B, Joshi K. Adherence, healthcare resource utilization and Medicaid spending associated with once-monthly paliperidone palmitate versus oral atypical antipsychotic treatment among adults recently diagnosed with schizophrenia. BMC Psychiatry 2017; 17:207. [PMID: 28576133 PMCID: PMC5457548 DOI: 10.1186/s12888-017-1358-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Once-monthly paliperidone palmitate (PP1M) is a long-acting injectable antipsychotic that may increase adherence rates, reduce hospitalizations, and lower medical costs compared to oral atypical antipsychotics (OAAs) among schizophrenia patients. However, the impact of PP1M in recently diagnosed patients remains unknown. The present study compared adherence, healthcare resource utilization and Medicaid spending between schizophrenia patients initiating PP1M versus OAA, among patients recently diagnosed (defined using ages 18-25 years as a proxy) and among the overall population. METHODS Medicaid data from five states (09/2008-03/2015) were used to identify adults with schizophrenia initiated on PP1M or OAAs (index date) on or after 09/2009. Outcomes were compared between PP1M and OAA groups following inverse probability of treatment weighting (IPTW). Univariate linear and Poisson regression models with nonparametric bootstrap procedures were used to compare the 12-month healthcare resource utilization and costs using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively. RESULTS Overall, patients initiated on PP1M (N = 2053) were younger (mean age: 41 vs. 44 years) and had more baseline antipsychotic use (88% vs. 62%) compared to OAA patients (N = 22,247). IPTW resulted in balanced baseline characteristics. Among recently diagnosed patients, PP1M was associated with better adherence (PDC ≥ 80%: 29% vs. 21%, P < 0.001) on the index medication as well as less use of other psychiatric medications, compared to OAAs. Adherence findings were similar for the overall cohort. Among recently diagnosed patients, lower medical costs associated with PP1M (MMCD = $-466; P = 0.028) outweighed the higher pharmacy costs (MMCD = $322; P < 0.001) resulting in similar total healthcare costs across groups (MMCD = $-144; P = 0.553). Overall, findings were similar but there was a trend toward a lower magnitude of medical cost savings (MMCD = $-286; P < 0.001). Reductions in medical costs were mainly driven by reductions in inpatient days (recently diagnosed RR = 0.85, P = 0.353; overall RR = 0.84, P = 0.004) and in home care visits (recently diagnosed RR = 0.43, P = 0.008; overall RR = 0.78, P = 0.048). CONCLUSIONS PP1M patients demonstrated significantly lower medical costs offsetting higher pharmacy costs relative to OAA patients. Recently diagnosed patients using PP1M may have greater medical cost savings relative to OAAs than that observed in the overall population, highlighting the potential economic impact of PP1M in adults recently diagnosed with schizophrenia.
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Affiliation(s)
- Dominic Pilon
- Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Suite 1200, Montréal, QC, H3B 4W5, Canada.
| | - Erik Muser
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Patrick Lefebvre
- Groupe d’analyse, Ltée, 1000 De La Gauchetière West, Suite 1200, Montréal, QC H3B 4W5 Canada
| | - Rhiannon Kamstra
- Groupe d’analyse, Ltée, 1000 De La Gauchetière West, Suite 1200, Montréal, QC H3B 4W5 Canada
| | - Bruno Emond
- Groupe d’analyse, Ltée, 1000 De La Gauchetière West, Suite 1200, Montréal, QC H3B 4W5 Canada
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
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Abstract
Data from a multiphase schizoaffective disorder study (NCT01193153) were used to examine the effects of paliperidone palmitate once-monthly (PP1M) by subjects' illness duration, defined as recent onset (≤5 years since first psychiatric diagnosis; n = 206) and chronic illness (>5 years; n = 461). Symptom and functioning scores, as measured during open-label PP1M acute and stabilization treatment phases, improved in both subpopulations, with greater improvements in recent onset than chronic illness subjects (p ≤ 0.022). Relapse rates, examined during the double-blind, placebo-controlled phase, were higher with placebo than PP1M: 30.0% vs. 10.2% (p = 0.014; hazard ratio [HR]: 2.8; 95% confidence interval [CI]: 1.11-7.12; p = 0.029) in the recent onset subpopulation and 35.5% vs. 18.1% (p = 0.001; HR: 2.38; 95% CI: 1.37-4.12; p = 0.002) in the chronic illness subpopulation. Growing evidence in the treatment of schizophrenia and schizoaffective disorder supports early intervention with long-acting antipsychotics.
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Zhao J, Li L, Shi J, Li Y, Xu X, Li K, Zhang L, Cai S, Feng Y, Zhuo J, Liu W, Lu H. Safety and efficacy of paliperidone palmitate 1-month formulation in Chinese patients with schizophrenia: a 25-week, open-label, multicenter, Phase IV study. Neuropsychiatr Dis Treat 2017; 13:2045-2056. [PMID: 28814873 PMCID: PMC5546821 DOI: 10.2147/ndt.s131224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Long-acting injectable (LAI) paliperidone palmitate 1-month formulation (PP1M) has demonstrated acceptable tolerability and favorable clinical outcomes in Western and Asian patients with schizophrenia. Hence, analysis of the outcomes of long-term PP1M treatment specifically in Chinese patients is of interest. OBJECTIVE The aim of this study is to evaluate the long-term safety and efficacy of PP1M treatment in Chinese patients with schizophrenia. METHODS In this 25-week, open-label, Phase IV study, patients (18-65 years) diagnosed with schizophrenia and having a baseline Positive and Negative Syndrome Scale (PANSS) total score of 60-120 (inclusive) were enrolled. All patients received injections of PP1M 150 mg eq. (day 1) and 100 mg eq. (day 8), followed by a flexible once-monthly maintenance dosing (75, 100, or 150 mg eq.). RESULTS Of the 353 patients, 234 (66.3%) completed the study treatment (mean age, 31.1 years; 52.7% men). The PANSS total score (primary end point) improved significantly over the 6-month treatment period (mean [standard deviation] change from baseline to end of treatment, -27.2 [18.30]; P<0.0001). The Clinical Global Impressions-Severity and Personal and Social Performance scores (secondary end points) also improved significantly (P<0.0001). At 6 months, PP1M had a positive impact on medication satisfaction, adherence, and increased preference for LAIs. Treatment-emergent adverse events (TEAEs) were reported by 181 (51.3%) patients (TEAEs ≥5%: extrapyramidal disorder [15.3%], akathisia [10.5%], blood prolactin increase [8.8%], insomnia [5.4%]). A total of 8 deaths were reported, including 4 completed suicides. CONCLUSION Long-term treatment with PP1M was efficacious, and no new safety concerns were identified in Chinese patients with schizophrenia. Overall, the results were comparable with observations from previous studies.
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Affiliation(s)
- Jingping Zhao
- Department of Psychiatry, The Mental Health Institute, The Second Xiangya Hospital of Central South University
| | - Lehua Li
- Department of Psychiatry, The Mental Health Institute, The Second Xiangya Hospital of Central South University
| | - Jianguo Shi
- Department of Psychiatry, Mental Health Center of Xi'an City
| | - Yi Li
- Department of Psychiatry, Mental Health Center of Wuhan City
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
| | - Keqing Li
- Department of Psychiatry, The Sixth People's Hospital of Hebei Province
| | - Lili Zhang
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
| | - Shangli Cai
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
| | - Yu Feng
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
| | - Jianmin Zhuo
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
| | - Weihong Liu
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
| | - Huafei Lu
- Department of Medical Affairs, Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
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Suzuki T. A further consideration on long-acting injectable versus oral antipsychotics in the treatment of schizophrenia: a narrative review and critical appraisal. Expert Opin Drug Deliv 2015; 13:253-64. [DOI: 10.1517/17425247.2016.1115479] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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