1
|
McKee KA, Crocker CE, Dikaios K, Otter N, Bardell A, Roy MA, Abdel-Baki A, Palaniyappan L, Malla A, Tibbo PG. Short communication: Prevalence of long-acting injectable antipsychotic use in Canadian early intervention services for psychosis. J Psychiatr Res 2023; 165:77-82. [PMID: 37480668 DOI: 10.1016/j.jpsychires.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
The use of long-acting injectable (LAI) antipsychotic drugs for psychotic disorders in Canada has been historically low compared to other jurisdictions despite advantages of LAIs in improving medication adherence and preventing relapse. In response, treatment recommendations were developed in 2013 by the Canadian Consortium for Early Intervention in Psychosis and other Canadian provincial expert groups. The impact of these guidelines needed to be assessed. To document practices in LAI use in early intervention services (EIS) for psychosis, Canadian EIS were surveyed in 2016 (n = 18) and 2020 (n = 12). Trends and descriptive information were examined using repeated cross-sectional survey data. Eight EIS responded to surveys at both time points allowing for longitudinal comparisons. Outcomes of interest included i) LAI use frequency, ii) timing of LAI starts, and iii) factors influencing LAI use. Cross-sectional analysis identified a significant increase in overall LAI usage (24.7% in 2016; 35.1% in 2020). Longitudinal analysis indicated that patients in the second program year saw the greatest increase in LAI use between 2016 and 2020 (25.6% vs. 36.1%), especially among patients under community treatment orders (65.5% vs. 81.5%). Results support increases in LAI use over time, accessibility, awareness, and increasing comfortability among Canadian clinicians.
Collapse
Affiliation(s)
- Kyle A McKee
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katerina Dikaios
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicola Otter
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada
| | - Andrea Bardell
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, University of British Columbia, Victoria, British Columbia, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc-André Roy
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Département de Psychiatrie et Neurosciences, Faculté de Médecine de L'Université Laval, Québec, Canada; Clinique Notre-Dame des Victoires, Centre Intégré Universitaire de La Capitale Nationale, Québec, Canada
| | - Amal Abdel-Baki
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, University of Montreal, Québec, Canada; Department of Psychiatry, Centre Hospitalier de L'Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de L'Université de Montréal, Canada
| | - Lena Palaniyappan
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada.
| |
Collapse
|
2
|
Roy MA. The Evolution of Long-Acting Antipsychotics Use in Québec between 2003 and 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:510-511. [PMID: 32030998 PMCID: PMC7298586 DOI: 10.1177/0706743720901975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc-André Roy
- Faculté de médecine, Université Laval, Québec, Québec, Canada.,Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale de Québec, CIUSSS Capitale-Nationale, Québec, Québec, Canada.,Centre de recherche CERVO, Québec, Québec, Canada
| |
Collapse
|
3
|
Masuda T, Misawa F, Takase M, Kane JM, Correll CU. Association With Hospitalization and All-Cause Discontinuation Among Patients With Schizophrenia on Clozapine vs Other Oral Second-Generation Antipsychotics: A Systematic Review and Meta-analysis of Cohort Studies. JAMA Psychiatry 2019; 76:1052-1062. [PMID: 31365048 PMCID: PMC6669790 DOI: 10.1001/jamapsychiatry.2019.1702] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Recent meta-analyses of randomized clinical trials (RCTs) comparing clozapine with nonclozapine second-generation antipsychotics (NC-SGAs) in schizophrenia have challenged clozapine's superiority in treatment-resistant patients. However, patients in RCTs are not necessarily generalizable to those in clinical practice. OBJECTIVE To conduct a systematic review and meta-analysis to compare various outcomes of clozapine vs oral NC-SGAs in cohort studies. DATA SOURCES Systematic literature search in PubMed, PsycINFO, and CINAHL without language restriction from database inception until December 17, 2018. STUDY SELECTION Nonrandomized cohort studies reporting effectiveness and/or safety outcomes comparing clozapine with NC-SGAs in schizophrenia or schizoaffective disorder. DATA EXTRACTION AND SYNTHESIS Independent investigators assessed studies and extracted data. Using a random-effects model, the study calculated risk ratio (RR) unadjusted for covariates and follow-up duration, number needed to treat/number needed to harm (NNT/NNH) for dichotomous data, and standardized mean difference (SMD) or mean difference (MD) for continuous data. MAIN OUTCOMES AND MEASURES Coprimary outcomes were hospitalization and all-cause discontinuation. Secondary outcomes included all effectiveness and safety outcomes reported in at least 3 analyzable studies. RESULTS Of 8446 hits, 68 articles from 63 individual cohort studies (n = 109 341) (60.3% male; mean [SD] age of 38.8 [6.5] years, illness duration of 11.0 [5.1] years, and study duration of 19.1 [23.3] months) were meta-analyzed. Compared with NC-SGAs, despite greater illness severity (17 studies [n = 38 766]; Hedges g, 0.222; 95% CI, 0.013-0.430; P = .04), clozapine was significantly associated with lower hospitalization risk (19 studies [n = 49 453]; RR, 0.817; 95% CI, 0.725-0.920; P = .001; NNT, 18; 95% CI, 12-40) and all-cause discontinuation (16 studies [n = 56 368]; RR, 0.732; 95% CI, 0.639-0.838; P < .001; NNT, 8; 95% CI, 6-12). Associations were statistically significant for comparisons with quetiapine fumarate and aripiprazole regarding hospitalization and all NC-SGAs, except aripiprazole, for all-cause discontinuation. Clozapine was also significantly associated with better outcomes regarding overall symptoms (SMD, -0.302; 95% CI, -0.572 to -0.032; P = .03) and Clinical Global Impressions scale severity (SMD, -1.182; 95% CI, -2.243 to -0.122; P = .03). Clozapine was significantly associated with increases in body weight (MD, 1.70; 95% CI, 0.31-3.08 kg; P = .02), body mass index (MD, 0.96; 95% CI, 0.24-1.68; P = .009), and type 2 diabetes (RR, 1.777; 95% CI, 1.229-2.570; P = .002; NNH, 27; 95% CI, 13-90). CONCLUSIONS AND RELEVANCE In cohort studies, despite more severely ill patients being treated with clozapine, use of clozapine was associated with better key efficacy outcomes and higher cardiometabolic-related risk outcomes vs NC-SGAs.
Collapse
Affiliation(s)
- Takahiro Masuda
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Sumitomo Dainippon Pharma Co, Ltd, Medical Affairs, Tokyo, Japan
| | - Fuminari Misawa
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Yamanashi Prefectural KITA Hospital, Yamanashi, Japan
| | - Masayuki Takase
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,Feinstein Institute for Medical Research, Manhasset, New York
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,Feinstein Institute for Medical Research, Manhasset, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
4
|
Sugawara N, Kudo S, Ishioka M, Sato Y, Kubo K, Yasui-Furukori N. Attitudes toward long-acting injectable antipsychotics among patients with schizophrenia in Japan. Neuropsychiatr Dis Treat 2019; 15:205-211. [PMID: 30666117 PMCID: PMC6330975 DOI: 10.2147/ndt.s188337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) are regarded as an important alternative to oral medication for patients with schizophrenia. However, LAIs remain under-utilized in clinical practice. AIMS The aims of this investigation were to 1) obtain information on patients' attitudes toward LAIs and 2) assess factors associated with patients' acceptance of LAIs, and 3) identify predictors of the discrepancy between patients and referring psychiatrists' opinions regarding the appropriateness for LAIs. METHODS Anonymized data were collected from a questionnaire distributed to 159 patients with schizophrenia and their referring psychiatrists at three psychiatric hospitals between February 2014 and July 2014. The patients completed an original questionnaire developed to evaluate their attitudes regarding LAIs. Regarding the appropriateness of LAI prescription, patients and their referring psychiatrists were asked to rate, on a 5-point scale, how appropriate they felt the depot prescription was for the patients. The participants also answered instruments to assess symptom severity, antipsychotic-induced extrapyramidal symptoms, functions, quality of life, and self-esteem levels. RESULTS Patients currently on LAIs have favorable attitudes toward LAIs with respect to side effects, relapse prevention, efficacy, pain, and cost. Expectation of relapse prevention was significantly associated with patients' acceptance of LAIs (answering that those drugs are appropriate for their own treatment). In addition, the discrepancy between the patients' and referring psychiatrists' opinions regarding the appropriateness of LAI treatment was significantly associated with symptom severity, expectation of relapse prevention, belief that LAIs are painful, and belief that LAIs offer a reduced range of antipsychotic choices. CONCLUSION Attitudes toward LAIs need to be considered when deciding whether to prescribe this formulation. Access to information on LAIs, including their benefit in relapse prevention, might enhance the acceptance and use of this formulation among patients with schizophrenia.
Collapse
Affiliation(s)
- Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan, .,Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
| | - Shuhei Kudo
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
| | - Masamichi Ishioka
- Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, Japan
| | - Yasushi Sato
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan, .,Department of Psychiatry, Seihoku-Chuoh Hospital, Goshogawara, Japan
| | - Kazutoshi Kubo
- Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
| |
Collapse
|
5
|
Einarson TR, Bereza BG, Tedouri F, Van Impe K, Denee TR, Dries PJT. Cost-effectiveness of 3-month paliperidone therapy for chronic schizophrenia in the Netherlands. J Med Econ 2017; 20:1187-1199. [PMID: 28762843 DOI: 10.1080/13696998.2017.1363050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND A new depot formulation of paliperidone has been developed that provides effective treatment for schizophrenia for 3 months (PP3M). It has been tested in phase-3 trials, but no data on its cost-effectiveness have been published. PURPOSE To determine the cost-effectiveness of PP3M compared with once-monthly paliperidone (PP1M), haloperidol long-acting therapy (HAL-LAT), risperidone microspheres (RIS-LAT), and oral olanzapine (oral-OLZ) for treating chronic schizophrenia in The Netherlands. METHODS A previous 1-year decision tree was adapted, based on local inputs supplemented with data from published literature. The primary analysis used DRG costs in 2016 euros from the insurer perspective, as derived from official lists. A micro-costing analysis was also conducted. For the costing scenario, official list prices were used. Clinical outcomes included relapses (treated as outpatients, requiring hospitalization, total), and quality-adjusted life-years (QALYs). Rates and utility scores were derived from the literature. Economic outcomes were the incremental cost/QALY-gained or relapse-avoided. Model robustness was examined in scenario, 1-way, and probability sensitivity analyses. RESULTS The expected cost was lowest with PP3M (8,781€), followed by PP1M (10,325€), HAL-LAT (11,278€), RIS-LAT (11,307€), and oral-OLZ (13,556€). PP3M had the fewest total relapses/patient (0.36, 0.94, 1.39, 1.21, and 1.70, respectively), hospitalizations (0.11, 0.46, 0.40, 0.56, and 0.57, respectively), emergency room visits (0.25, 0.48. 0.99, 0.65, and 1.14, respectively) and the most QALYs (0.847, 0.735, 0.709, 0.719, and 0.656, respectively). In both cost-effectiveness and cost-utility analyses, PP3M dominated all other drugs. Sensitivity analyses confirmed base case findings. In the costing analysis, total costs were, on average, 31.9% higher than DRGs. CONCLUSIONS PP3M dominated all commonly used drugs. It is cost-effective for treating chronic schizophrenia in the Netherlands. Results were robust over a wide range of sensitivity analyses. For patients requiring a depot medication, such as those with adherence problems, PP3M appears to be a good alternative anti-psychotic treatment.
Collapse
Affiliation(s)
- Thomas R Einarson
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | - Basil G Bereza
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | - Fadi Tedouri
- b Janssen Janssen Pharmaceutica NV , Beerse , Belgium
| | | | - Tom R Denee
- c Janssen-Cilag BV , Tilburg , The Netherlands
| | | |
Collapse
|
6
|
Land R, Siskind D, McArdle P, Kisely S, Winckel K, Hollingworth SA. The impact of clozapine on hospital use: a systematic review and meta-analysis. Acta Psychiatr Scand 2017; 135:296-309. [PMID: 28155220 DOI: 10.1111/acps.12700] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness. METHOD PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports. RESULTS Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P < 0.001, 22 studies, n = 44 718). There were significantly fewer bed days after clozapine treatment compared to before clozapine treatment in both controlled (MD = -34.41 days; 95% CI: -68.22 to -0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = -52.86 days; 95% CI: -79.86 days to -25.86 days, P < 0.001, n = 2917). Clozapine and control medicines had a similar time to rehospitalisation (-19.90 days; 95% CI: -62.42 to 22.63 days, P = 0.36). CONCLUSION Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia.
Collapse
Affiliation(s)
- R Land
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia
| | - D Siskind
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - P McArdle
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - S Kisely
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - K Winckel
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia.,Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - S A Hollingworth
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia
| |
Collapse
|
7
|
Rezansoff SN, Moniruzzaman A, Fazel S, Procyshyn R, Somers JM. Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1623-1632. [PMID: 27338740 PMCID: PMC5091737 DOI: 10.1007/s00127-016-1259-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live. METHOD Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio. RESULTS Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio. CONCLUSIONS This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication.
Collapse
Affiliation(s)
- Stefanie N Rezansoff
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - A Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 0X3 7JX, UK
| | - R Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - J M Somers
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| |
Collapse
|
8
|
Lafeuille MH, Dean J, Carter V, Duh MS, Fastenau J, Dirani R, Lefebvre P. Systematic review of long-acting injectables versus oral atypical antipsychotics on hospitalization in schizophrenia. Curr Med Res Opin 2014; 30:1643-55. [PMID: 24730586 DOI: 10.1185/03007995.2014.915211] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the impact of long-acting injectables (LAIs) versus oral antipsychotics (OAs) on hospitalizations among patients with schizophrenia by conducting a systematic literature review of studies with different study designs and performing a meta-analysis. METHODS Using the PubMed database and major psychiatric conference proceedings, a systematic literature review for January 2000 to July 2013 was performed to identify English-language studies evaluating schizophrenia patients treated with atypical antipsychotics. Studies reporting hospitalization rates as a percentage of patients hospitalized or as the number of hospitalizations per person per year were selected. The primary meta-analysis assessed the percentage decrease in hospitalization rates before and after treatment initiation for matched time periods. The secondary meta-analysis assessed the absolute rate of hospitalization during follow-up. Pooled treatment-effect estimates were calculated using random-effects models. To account for differences in patient and study-level characteristics between studies, meta-regression analyses were used. Subset analyses further explored the heterogeneity across study designs. RESULTS Fifty-eight studies evaluating 25 arms (LAIs: 13 arms, 4516 patients; OAs: 12 arms, 23,516 patients) in the primary meta-analysis and 78 arms (LAIs: 12 arms, 4481 patients; OAs: 66 arms, 96,230 patients) in the secondary meta-analysis were identified. Reduction in hospitalization rates for LAIs was 20.7 percentage points higher than that of OAs (random-effects estimates: LAIs = 56.2% vs. OAs = 35.5%, P = 0.023). Controlling for patient and study characteristics, the adjusted percentage reduction in hospitalization rates for LAIs was 26.4 percentage points higher than for OAs (95% CI: 3.3-49.5, P = 0.027). As for the secondary meta-analysis, no significant difference between LAIs and OAs was observed (random-effects estimate: -8.6, 95% CI: -18.1-1.0, P = 0.077). Subset analyses across type of study yielded consistent results. Limitations of this analysis include the long observation period, which may not reflect current treatment patterns, the use of all-cause hospitalization, which may not be solely related to schizophrenia, and the fact that most studies in the LAI cohort evaluated risperidone. CONCLUSION The primary results of this meta-analysis, including studies with both interventional and non-interventional designs and using meta-regressions, suggest that LAIs are associated with higher reductions in hospitalization rates for schizophrenia patients compared to OAs.
Collapse
|
9
|
Abstract
Depot formulations are not widely used in everyday practice. This study aimed to assess psychiatrists' attitudes toward the use of long-acting injectable (LAI) antipsychotics in schizophrenia. We interviewed 113 French psychiatrists about the factors that influenced their prescription of LAI antipsychotics. Multidimensional and cluster analyses were used to detect correlations. The most important factor against the use of LAI antipsychotics is a sufficient estimated compliance with the oral formulation. For first-generation LAI, the main factor is the risk for extrapyramidal symptoms; and for second-generation LAI, it is the unavailability of the equivalent oral formulation. Four factors incite the psychiatrists to prescribe LAI. Two different clusters of patients can also be identified. Most factors influencing the clinicians' attitudes toward the use of LAI antipsychotics are shared in many countries. Conversely, some attitudes related to organizational aspects, particularly the relevance of health care costs, may vary from one country to another.
Collapse
|
10
|
Manchanda R, Chue P, Malla A, Tibbo P, Roy MA, Williams R, Iyer S, Lutgens D, Banks N. Long-acting injectable antipsychotics: evidence of effectiveness and use. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:5S-13S. [PMID: 23945067 DOI: 10.1177/088740341305805s02] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the evidence for the role of long-acting injectable (LAI) antipsychotics (APs), especially the second-generation AP (SGA) LAIs, in the treatment of schizophrenia and to discuss the use rates of LAIs in Canada. METHOD A search of online medical databases was conducted of the published literature (1995-2012) of the effects of LAIs on the domains of remission, adherence, relapse, and hospitalization. Results obtained from randomized controlled trials (RCTs), systematic reviews, meta-analyses, and large-scale observational studies were included. Expert consensus data were also solicited on LAI use within a Canadian context. RESULTS While the efficacy of LAIs, compared with placebo, is well established, the evidence from RCTs is equivocal for any specific advantage for SGA LAIs, compared with oral medications, probably owing to challenges in conducting such RCTs. Evidence from methodologically less rigorous studies and from clinical practice suggests some advantages in achieving and maintaining remission, risk of relapse, and hospitalization. The rate of LAI (first-generation AP and SGA) use from published outpatient studies is low at 6.3% in Canada, compared with 15% to 80% worldwide. However, there is a relatively high rate of use in specific early psychosis programs and in conjunction with community treatment orders in Canada. CONCLUSIONS LAIs are at least as effective as oral APs in the treatment of psychotic disorders. The former may have specific advantages for patients who demonstrate covert nonadherence. The underuse of LAIs in Canada needs to be better understood and addressed.
Collapse
Affiliation(s)
- Rahul Manchanda
- Professor, Department of Psychiatry, Western University, London, Ontario; Director, Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ascher-Svanum H, Montgomery WS, McDonnell DP, Coleman KA, Feldman PD. Treatment-completion rates with olanzapine long-acting injection versus risperidone long-acting injection in a 12-month, open-label treatment of schizophrenia: indirect, exploratory comparisons. Int J Gen Med 2012; 5:391-8. [PMID: 22615534 PMCID: PMC3355848 DOI: 10.2147/ijgm.s29052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Little is known about the comparative effectiveness of atypical antipsychotics in long-acting injection formulation. Due to the absence of head-to-head studies comparing olanzapine long-acting injection and risperidone long-acting injection, this study was intended to make exploratory, indirect, cross-study comparisons between the long-acting formulations of these two atypical antipsychotics in their effectiveness in treating patients with schizophrenia. METHODS Indirect, cross-study comparisons between olanzapine long-acting injection and risperidone long-acting injection used 12-month treatment-completion rates, because discontinuation of an antipsychotic for any cause is a recognized proxy measure of the medication's effectiveness in treating schizophrenia. Following a systematic review of the literature, two indirect comparisons were conducted using open-label, single-cohort studies in which subjects were stabilized on an antipsychotic medication before depot initiation. The first analysis compared olanzapine long-acting injection (one study) with pooled data from nine identified risperidone long-acting injection studies. The second analysis was a "sensitivity analysis," using only the most similar studies, one for olanzapine long-acting injection and one for risperidone long-acting injection, which shared near-identical study designs and involved study cohorts with near-identical patient characteristics. Pearson Chi-square tests assessed group differences on treatment-completion rates. RESULTS Comparison of olanzapine long-acting injection data (931 patients) with the pooled data from the nine risperidone long-acting injection studies (3950 patients) provided almost identical 12-month treatment-completion rates (72.7% versus 72.4%; P = 0.87). When the two most similar studies were compared, the 12-month completion rate for olanzapine long-acting injection was significantly higher than for risperidone long-acting injection (81.3% versus 47.0%; P < 0.001). However, any conclusions drawn from this comparison may be limited by differences in the studies' geographic catchment areas. CONCLUSION Using treatment-completion rates as a proxy measure of medication effectiveness, olanzapine long-acting injection did not differ significantly from risperidone long-acting injection when including all eligible studies. However, the findings of this exploratory analysis should be interpreted with caution, considering the methodological limitations of these indirect, cross-study comparisons.
Collapse
Affiliation(s)
- Haya Ascher-Svanum
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | - Peter D Feldman
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| |
Collapse
|
12
|
Stip E, Abdel-Baki A, Bloom D, Grignon S, Roy MA. [Long-acting injectable antipsychotics: an expert opinion from the Association des médecins psychiatres du Québec]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:367-76. [PMID: 21756451 DOI: 10.1177/070674371105600608] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To present points of agreement and disagreement about antipsychotics. Since the appearance of 2nd generation long-acting antipsychotics (LAA), and given the high frequency of noncompliance with antipsychotics in psychotic disorders, LAAs have attracted more interest in psychiatric literature. However,their use is suboptimal, globally, and is also subject to significant national disparities. ln this context,the Association des médecins psychiatres du Québec (AMPQ) has asked for a review of the evidence concerning LAA efficiency and tolerance, and has called for consensual c1inical reflection on the benefits and obstacles of prescribing them, as weil as potential solutions, including administrative and judiciary dimensions. METHODS The AMPQ established an expert committee, from 4 Quebec universities, which was responsible for preparing the review paper. The committee intended to appropriately provide c1inicians with the different aspects of LAA use. The committee produced a qualitative and selective review. RESULTS Mean LAA prescription rates observed in Canada are around 6% and data to confirm this are scarce. A 15% to 25% rate could be suggested. CONCLUSION The committee has submitted the Quebec long-acting antipsychotic algorithm (QAAPAPLE, derived from the French acronym) as a result of the consensus reached by the 4 university psychiatry departments.
Collapse
Affiliation(s)
- Emmanuel Stip
- Département de psychiatrie de l'Université de Montréal.
| | | | | | | | | |
Collapse
|
13
|
Pechlivanoglou P, Vehof J, van Agthoven M, de Jong-van den Berg LTW, Postma MJ. Diffusion of a new drug: a comparative analysis of adoption, treatment complexity, and persistence of risperidone long-acting injectable therapy in the Netherlands. Clin Ther 2010; 32:108-18. [PMID: 20171417 DOI: 10.1016/j.clinthera.2010.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study's objective was to analyze the adoption and persistence of risperidone long-acting injectable (RLAI) therapy after its introduction in the Netherlands in 2003 compared with the adoption and persistence of existing first-generation antipsychotic (FGA) depot drugs as an example of the diffusion of a new drug in the Netherlands. METHODS Data on antipsychotic use were obtained from the InterAction DataBase (IADB.nl), a database containing pharmacy dispensing records of patients in the northern Netherlands, from May 20, 2003, to December 31, 2006. Treatment complexity for patients prescribed RLAI was analyzed on the basis of psychotropic comedication at baseline and during treatment, as well as on the number of previous antipsychotic therapies. Differences in treatment complexity between patients using RLAI and those using FGA depot drugs were estimated using parametric regressions. To evaluate persistence, survival analysis techniques were applied to estimate the probability of patients continuing the use of RLAI or FGA depot drugs over time. RESULTS Data on 435 patients who were treated with depot antipsychotics were extracted from the IADB.nl. Patients had a mean (SD) age of 40.7 (13.8) years, and 65% of them were male. The results of this analysis indicated that persistence for patients prescribed RLAI was significantly lower compared with other depot antipsychotics (RLAI vs zuclopenthixol, P = 0.002; RLAI vs all other depot antipsychotics, P = 0.009). At the initiation of treatment, patients prescribed RLAI had more previous psychotropic comedication and had, on average, approximately 5 and approximately 1.5 times more prior depot drug therapies compared with zuclopenthixol and any other FGA depot drug, respectively. CONCLUSIONS The findings of this study suggest that RLAI has been prescribed more often for difficult-totreat patients than have other available depot antipsychotics. This may explain the low adoption and poor persistence observed in the first few years after the introduction of RLAI. Further research with more extensive data should be pursued to obtain better understanding of the current diffusion of RLAI in daily clinical practice.
Collapse
Affiliation(s)
- Petros Pechlivanoglou
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | | | | | | | | |
Collapse
|
14
|
Karagianis J, Williams R, Davis L, Procyshyn R, Monga N, Hanley J, Chandrasena R, Thakur A, Dickson R. Antipsychotic switching: results from a one-year prospective, observational study of patients with schizophrenia. Curr Med Res Opin 2009; 25:2121-32. [PMID: 19601707 DOI: 10.1185/03007990903102966] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Health Outcomes of a Canadian Community Cohort (HOCCC) study is a 1-year prospective observational study of outpatients with schizophrenia or related psychotic disorders. The purpose of the study was to compare effectiveness of antipsychotic treatment as measured by 1-year treatment completion rates. DESIGN AND METHODS Patients (N = 929) were enrolled if in the course of usual clinical practice they switched to a second-generation antipsychotic (SGA). Observational data were collected for up to 1 year. The primary analysis compared 1-year treatment-completion rates for the olanzapine cohort with the other SGA cohort (quetiapine, risperidone, clozapine), using a chi-squared test. RESULTS Of 929 patients enrolled, 64.8% (516/796) of evaluable patients completed 1 year of treatment. There was no statistically significant difference in the proportion of treatment completers between the olanzapine cohort (67.4%, 256/380) and the other SGA cohort (62.5%, 260/416). Treatment-completion rates were risperidone 62.0% (127/205), quetiapine 63.7% (123/193) and clozapine 55.6% (10/18). Antipsychotic polypharmacy was common. Patients treated with olanzapine or risperidone had significantly higher increases in BMI than quetiapine-treated patients. There were no major differences between olanzapine monotherapy and pooled other SGA monotherapy groups in status of extrapyramidal symptoms from baseline to endpoint. CONCLUSIONS Olanzapine and other SGAs exhibited similar rates of 1-year treatment completion. Further study of medication combinations is needed, given their perceived clinical value, and the high frequency of antipsychotic polypharmacy in clinical practice. LIMITATIONS As most patients received several psychotropics and power was reduced in monotherapy analyses, comparisons between cohorts must be interpreted cautiously. Comparisons between individual antipsychotics were post hoc and not powered a priori. Accuracy and completeness of adverse event information for drugs other than olanzapine is limited.
Collapse
|
15
|
Peuskens J, Gillain B, De Graeve D, Van Vleymen B, Albert A. Belgian Schizophrenia Outcome Survey - results of a 2-year naturalistic study in patients stabilised on monotherapy with olanzapine, risperidone or haloperidol. Eur Psychiatry 2008; 24:154-63. [PMID: 19118983 DOI: 10.1016/j.eurpsy.2008.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode. METHODS Adults stabilised with haloperidol, olanzapine or risperidone entered this observational study <or=1 month after discharge and were assessed at baseline, 3, 6, 12, 18 and 24 months using Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Global Assessment of Functioning and adverse events reporting. RESULTS Among 323 patients (haloperidol 32, olanzapine 149, risperidone 142), baseline characteristics were similar in the olanzapine and risperidone groups, except for more first episodes in the risperidone group (p=0.01). Haloperidol patients were more often single and institutionalised, less educated, had more residual schizophrenia, were longer hospitalised in the previous year, took more corrective and psychotropic drugs and had more extrapyramidal symptoms (EPS) and gynaecomastia (all significantly). Sixty-eight percent of patients completed a 2-year follow-up. In all groups, CGI and GAF improved during the first 3 months (both p<0.0001) while BPRS deteriorated in the first year (all within group changes p<0.05, between group changes NS) before it stabilised. There were no significant differences in hospitalisations and no change in social profile. At the last visit, 66% of haloperidol (p<0.01), 35% of olanzapine (NS) and 39% (NS) of risperidone patients had >or=1 EPS; 69% (p<0.013), 40 and 44%, respectively, had >or=1 sexual problem (NS). Mean weight gain was 0.4 (NS), 2.6 (p<0.05) and 2.6 kg (p<0.05), respectively. CONCLUSIONS In this naturalistic study, treatment allocation might have introduced a bias in the interpretation of efficiency results, but olanzapine and risperidone caused less EPS than haloperidol during 2 years of outpatient follow-up.
Collapse
Affiliation(s)
- J Peuskens
- Universitair Psychiatrisch Centrum Katholieke Universiteit Leuven, Campus St. Jozef Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
| | | | | | | | | |
Collapse
|
16
|
Lindström E, Eberhard J, Levander S. Five-year follow-up during antipsychotic treatment: efficacy, safety, functional and social outcome. Acta Psychiatr Scand 2007:5-16. [PMID: 17953521 DOI: 10.1111/j.1600-0447.2007.01083.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Explore the long-term course of schizophrenia and related disorders. METHOD Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. RESULTS Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. CONCLUSION The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.
Collapse
Affiliation(s)
- E Lindström
- Department of Neuroscience-Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | | | | |
Collapse
|
17
|
Lasalvia A, Bonetto C, Cristofalo D, Tansella M, Ruggeri M. Predicting clinical and social outcome of patients attending 'real world' mental health services: a 6-year multi-wave follow-up study. Acta Psychiatr Scand 2007:16-30. [PMID: 17973807 DOI: 10.1111/j.1600-0447.2007.01090.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aims of this study were: i) to determine changes in symptoms and social disability, and ii) to explore predictors of clinical and social outcome in patients receiving community-based mental health care. METHOD A total of 354 patients treated in the South-Verona Community Mental Health Service were followed up over 6 years (with assessments made at baseline, 2 and 6 years) by using a set of standardized measures exploring psychopathology (Brief Psychiatric Rating Scale) and social disability (Disability Assessment Schedule). Generalized linear latent and mixed models were used to explore longitudinal predictors of clinical and social outcome. RESULTS Psychotic patients displayed clinical and social outcome characterized by complex patterns of exacerbation and remission over time; however, a clear trend towards a deteriorating course was not found, thus challenging the notion that psychotics are fatally prone to a destiny of chronicity. Non-psychotics reported a significant reduction in the core symptom of depression and in the observable physical and motor manifestations of tension and agitation, and a parallel increase in complaints about their physical health. Clinical and social dimensions of outcome are influenced by specific and different set of predictors. CONCLUSION The results of this study confirm the need to implement naturalistic outcome studies conducted in the 'real world' services to inform decisions and strategies to be adopted in routine clinical practice.
Collapse
Affiliation(s)
- A Lasalvia
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
| | | | | | | | | |
Collapse
|