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Wang G, Huang H, Wang Y, Yang Y, Li C, Luo S, Li Y. A randomized, prospective, active-controlled study comparing intramuscular long-acting paliperidone palmitate versus oral antipsychotics in patients with schizophrenia at risk of violent behavior. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110897. [PMID: 37972752 DOI: 10.1016/j.pnpbp.2023.110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Paliperidone palmitate (PP) is an effective long-acting antipsychotic injection, but its impact on the behavior of schizophrenia patients with dangerous tendencies requires further investigation. This study aims to explore the effects of long-term antipsychotic treatment on this population in the community. METHODS This 49-week, randomized controlled trial was conducted across 21 communities in Wuhan and enrolled 134 schizophrenia patients at risk for violent behavior. With a fixed block size of 10, participants were randomly assigned to receive either intramuscular PP 1-month formulation (PP1M) or oral antipsychotic medication (OAP) at a 1:1 ratio. Changes in patients' risk for violent/aggressive behavior, family burden, social, and cognitive functioning were measured using VRAPP, MOAS, PANSS, FBS, PSP, and RBANS scales from baseline to endpoint. Longitudinal data from multiple repeated measures were analyzed using linear mixed-effects models. RESULTS The study protocol was completed by 77.6% of the patients overall. Significant improvements were observed in the risk assessment scores, MOAS total score, PANSS total score, PSP total score, and FBS total score of patients in the PP1M group from baseline to the end of treatment (all P < 0.05). Importantly, compared to patients in the OAP group, the improvements in these measures were also significantly greater in the PP1M group. Commonly observed AEs, such as hyperprolactinemia (70.3% vs. 62.65%) and muscle tension (45.3% vs. 57.8%), were considered to be the PP-related AEs. Nonetheless, the differences between the two groups did not reach statistical significance, and no new safety concerns emerged. CONCLUSIONS Our study suggests that PP long-acting injection (LAI) is a safe and effective treatment option for community-dwelling schizophrenia patients with impulsive violence and risky behaviors.
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Affiliation(s)
- Gang Wang
- Wuhan, Mental Health Center, Wuhan, China
| | | | - Yijun Wang
- Wuhan, Mental Health Center, Wuhan, China
| | | | - Chang Li
- Wuhan, Mental Health Center, Wuhan, China
| | - Sen Luo
- Wuhan, Mental Health Center, Wuhan, China
| | - Yi Li
- Wuhan, Mental Health Center, Wuhan, China..
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Li Q, Li X, Ye C, Jia M, Si T. Characteristics of patients with schizophrenia switching from oral antipsychotics to once-monthly paliperidone palmitate (PP1M): a systematic review. BMC Psychiatry 2024; 24:57. [PMID: 38243208 PMCID: PMC10799459 DOI: 10.1186/s12888-024-05508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The utilization of once-monthly paliperidone palmitate (PP1M) in schizophrenia treatment has increased due to its enhanced adherence and convenience. However, there is limited evidence on patient characteristics that may influence treatment outcomes when switching from oral antipsychotics (OAPs) to PP1M therapy. This systematic review aims to identify such patient characteristics and explore potential beneficial factors to aid healthcare professionals in clinical practice. METHODS A systematic literature search was conducted in the PubMed, Embase, and Cochrane Library databases up to July 19, 2022. Studies related to patients with schizophrenia who had been previously treated with OAPs and switched to PP1M were identified and included. Outcomes included the Positive and Negative Syndrome Scale (PANSS) total score, the clinical Global Impressions - Severity (CGI-S) score, the Personal and Social Performance (PSP) total score, and hospitalisation rate. Data were independently extracted and analysed. The results were presented through a narrative synthesis. RESULTS Eleven studies with a total of 4150 patients were included, identifying nine potential characteristics. The most commonly reported characteristics was patient's prior treatment with OAPs, followed by the stage of disease, duration of illness (DI), ethnicity, reason for switching to PP1M, history of hospitalisation, time of start injection of PP1M, the PANSS and PSP total score at baseline. Patients in the acute stage, with a shorter DI, a less than 1-week time interval to PP1M injection, and a lower PANSS total score at baseline may have a trend on providing better improvements on PANSS total score. Acute stage and shorter DI also showed potential trends in reducing CGI-S score. Early initiation of PP1M, switching for reasons other than lack of efficacy, and a higher PSP score at baseline exhibited potential trends towards better PSP total score improvements. CONCLUSION Our findings may suggest that patients in acute stage, with a shorter duration of illness, with early initiation of PP1M injection, and lower PANSS or PSP scores may trend towards better clinical results when transitioning to PP1M from OAPs. Further research is necessary to validate these potential associations and identify any unexplored characteristics. Such investigations are crucial for providing comprehensive clinical recommendations and informing treatment strategies in this context.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Uribe ES, Mundo SEO, Garza RRM, Gonzalez-Colmenero FD, Sanchez LM, Cantu CBE, Arellano MM, Montemayor YYH, Morales PLC, Juarez SBM, Rojo-Garza SS. Comparative Safety of Long-Acting Injectable Antipsychotics: A Systematic Review and Network Meta-Analysis. Psychiatry Investig 2023; 20:1112-1125. [PMID: 38163650 PMCID: PMC10758324 DOI: 10.30773/pi.2022.0216] [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: 08/03/2022] [Revised: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective disorder (SZA). METHODS We performed a systematic review and a network meta-analysis of randomized controlled trials (RCTs) comparing the safety of LAIs versus other LAIs or placebo in adults diagnosed with SCZ or SZA. The primary outcomes were treatment emergent adverse events (TEAEs), serious treatment emergent adverse events (STEAEs), and deaths. The secondary outcomes included treatment discontinuations due to adverse events and all-cause discontinuations. RESULTS Seventeen RCTs were included (n=7,908). There were no significant differences between LAIs and placebo in the risk of presenting TEAEs. LAIs had a significant lower risk of presenting STEAEs except for aripiprazole. No significant differences in deaths were found. LAIs showed a significant protective effect against all-cause discontinuation, except for haloperidol. Only aripiprazole had a significantly lower risk of treatment discontinuation due to adverse events. CONCLUSION We found no significant differences in the risk of presenting TEAEs between LAIs and placebo. The majority of LAIs had a significantly lower risk of presenting STEAEs than placebo. Development of international guidelines for the report of safety outcomes related to antipsychotics especially for LAIs in clinical trials could minimize report and interpretation biases and improve the accuracy of posterior meta-analysis.
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Affiliation(s)
- Erasmo Saucedo Uribe
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Samuel Enrique Olivares Mundo
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Raul Ricardo Medrano Garza
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Fernando Diaz Gonzalez-Colmenero
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Lorena Martinez Sanchez
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Cesar Bigran Espinosa Cantu
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Martin Moreno Arellano
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Yessica Yaneth Herrera Montemayor
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Patricia Lizeth Castillo Morales
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Samantha Berenice Medrano Juarez
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Sandra Sabrina Rojo-Garza
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
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Ma N, Zhang L, Zhang W, He Y, Ye C, Li X. Long-Acting Injectable Antipsychotic Treatment for Schizophrenia in Asian Population: A Scoping Review. Neuropsychiatr Dis Treat 2023; 19:1987-2006. [PMID: 37745189 PMCID: PMC10516218 DOI: 10.2147/ndt.s413371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Evidence of comparative benefits of long-acting injectable (LAI) antipsychotics in Asian patients with schizophrenia has been inconsistent. This scoping review aimed to synthesize the current evidence in the past ten years and provide an overview of efficacy, safety, treatment adherence, patient attitudes, and healthcare resource utilization of LAI in this population. A systematic search was conducted with a pre-defined search strategy in six electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Embase, CINAHL, and PsycArticles. A total of 46 studies were included, including 15 cohort studies, 13 single-arm trials, 10 randomized controlled trials, four mirror-image studies, three cross-sectional studies, and one controlled clinical trial. Paliperidone palmitate once-monthly injection (27/46) and risperidone LAI (14/46) were the most frequently investigated LAIs. Compared with oral antipsychotic medications (OAMs), LAIs demonstrated a lower rate of relapse/hospitalization and comparable improvement in efficacy. Adverse events (AEs) were similar between LAIs and OAMs, although types and incidence varied. Significant reduction in the length of hospitalization and number of outpatient visits/inpatient admission was observed after initiation of LAIs. These findings suggest that LAI demonstrated comparable efficacy and safety among Asian populations with schizophrenia in comparison to OAMs. Better adherence and lower relapse were observed in patients receiving LAIs from published evidence. Future research is warranted to better understand the comprehensive performance of LAI in specific population or context.
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Affiliation(s)
- Ning Ma
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Lei Zhang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Wufang Zhang
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Yingying He
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Chong Ye
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Xin Li
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
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Li Q, Li X, Ye C, Jia M, Si T. Effectiveness and Safety of Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate (PP1M) in the Management of Schizophrenia: A Systematic Review and Meta-Analysis. CNS Drugs 2023; 37:695-713. [PMID: 37490267 PMCID: PMC10439041 DOI: 10.1007/s40263-023-01028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Considering the improvement in adherence and convenience, once-monthly paliperidone palmitate (PP1M) has been increasingly used in the treatment of schizophrenia. However, the outcomes for patients who switch from oral antipsychotics (OAPs) to PP1M have not been reliably assessed. The objective of this systematic review and meta-analysis was to investigate the efficacy and safety of PP1M in the management of patients with schizophrenia with a prior history of OAP use. METHODS We conducted a systematic search in PubMed, EMBASE, and the Cochrane Library on 19 July 2022 to identify eligible studies. All studies that examined the effectiveness and safety of switching from OAPs to PP1M in patients with schizophrenia were included. The primary outcomes were relapse rate, hospitalisation rate, and the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score. The secondary outcomes included the changed number of inpatient visits, changed length of stay hospitalisation, change from baseline in the Clinical Global Impressions-Severity (CGI-S) score and the personal and social performance (PSP) total score, response rate, proportion of treatment discontinuation, and adverse events. We included randomised-controlled trials (RCTs), single-arm studies, and observational studies. Case reports, case series, and reviews were excluded. The quality assessment of included studies was performed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), the 9-point Newcastle-Ottawa Scale (NOS) instrument for non-randomised studies and cohort studies, and the 12-item National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study without control group. Follow-up times were reported as short- (≤ 13 weeks), medium- (14-26 weeks), and long term (≥ 27 weeks). Data were pooled using meta-analysis. RESULTS Fifteen studies with a total of 4740 patients were included. The long-term relapse rates and hospitalisation rates were 12% (95% CI 0.07-0.18) and 18% (95% CI 0.15-0.20), respectively. The short-, medium-, and long-term change in PANSS total score was - 21.69 (95% CI - 30.02 to -13.36), - 14.98 (95% CI - 21.45 to - 8.51) and - 17.88 (95% CI - 31.94 to -3.82), respectively. Approximately 50% of patients reported at least a 30% reduction in the PANSS score at the short-term follow-up. Improvements in CGI-S and PSP score were observed during various periods. There was a reduction in the length of stay hospitalisation and the number of inpatient visits at the medium- and long-term follow-ups. Low discontinuation and adverse event rates were reported. CONCLUSION Based on our findings, this study may support the efficacy and safety of switching from OAPs to PP1M for the treatment of patients with schizophrenia. Future large-scale studies are warranted to confirm our findings.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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TAŞCI G, ÖZSOY F. Comparison of prolactin level, sexual function, body mass index, and liver function tests in patients using depot antipsychotics. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1128200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Bu çalışmada uzun etkili antipsikotik ilaç formları (uzun etkili paliperidon palmitat, risperidon depo ve zuklopentiksol depo) kullanan hastalarda cinsel işlev bozuklukları, vücut kitle indeksi, karaciğer fonksiyon testleri ve prolaktin düzeylerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmaya şizofreni tanılı ve uzun etkili antipsikotik tedavisi alan hastalar dahil edildi. Tüm katılımcılara demografik veri formu, Pozitif ve Negatif Sendrom Ölçeği (PANSS), Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ) ve Arizona Cinsel Yaşantılar Ölçeği (ACYÖ) uygulandı. Ardından üre, kreatinin, karaciğer fonksiyon testleri, kolesterol ve prolaktin düzeylerini değerlendirmek için venöz kan örnekleri alındı.
Bulgular: Çalışmaya 95 hasta dahil edildi. Dahil edilenlerin 79’u erkek (%83.2) ve 16’sı kadındı (%16.8). Tüm hastaların yaş ortalaması 36.77±10.24 yıl idi. Vücut kitle indeksleri ortalaması ise 27.06±4.95 kg/m2 idi. Gruplar arasında ACYÖ ve CŞDÖ skorları açısından farklılık saptanmadı. Prolaktin değeri paliperidon depo kullanan hastalarda zuklopentiksol depo kullanan hastalardan yüksek olarak hesap edilmiştir.
Sonuç: Sonuçlarımıza göre cinsel işlevleri etkileyen prolaktin değerleri, hastalar semptom belirtmese de uzun etkili antipsikotik kullanan hastalarda göz önünde bulundurulmalıdır. Uzun etkili antipsikotik kullanımının hem prolaktin değerleri hem de diğer laboratuvar parametrelerine olan etkileri konusunda ileri araştırmalar yapılmalıdır.
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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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Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics. NPJ SCHIZOPHRENIA 2022; 8:5. [PMID: 35210430 PMCID: PMC8873492 DOI: 10.1038/s41537-021-00192-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/02/2021] [Indexed: 01/27/2023]
Abstract
Clinical practice guidelines (CPGs) translate evidence into recommendations to improve patient care and outcomes. To provide an overview of schizophrenia CPGs, we conducted a systematic literature review of English-language CPGs and synthesized current recommendations for the acute and maintenance management with antipsychotics. Searches for schizophrenia CPGs were conducted in MEDLINE/Embase from 1/1/2004–12/19/2019 and in guideline websites until 06/01/2020. Of 19 CPGs, 17 (89.5%) commented on first-episode schizophrenia (FES), with all recommending antipsychotic monotherapy, but without agreement on preferred antipsychotic. Of 18 CPGs commenting on maintenance therapy, 10 (55.6%) made no recommendations on the appropriate maximum duration of maintenance therapy, noting instead individualization of care. Eighteen (94.7%) CPGs commented on long-acting injectable antipsychotics (LAIs), mainly in cases of nonadherence (77.8%), maintenance care (72.2%), or patient preference (66.7%), with 5 (27.8%) CPGs recommending LAIs for FES. For treatment-resistant schizophrenia, 15/15 CPGs recommended clozapine. Only 7/19 (38.8%) CPGs included a treatment algorithm.
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Shin W, Lee DH, Kim MK, Lee SH, Cho DY, Bang M. Clinical effectiveness of early treatment with paliperidone palmitate in schizophrenia: A retrospective real-world study in South Korea. Early Interv Psychiatry 2021; 15:1759-1767. [PMID: 33445224 DOI: 10.1111/eip.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
AIM Long-acting injectable antipsychotic agents (LAIs) including paliperidone palmitate (PP) have shown promising results in preventing relapse and rehospitalization in schizophrenia. This study aimed to ascertain the comparative real-world effectiveness between the early and late administration of PP and oral formulations of risperidone and paliperidone (ORPs) in patients experiencing a first episode or relapse of schizophrenia. METHODS We identified patients with schizophrenia admitted to a psychiatric ward at least once and treated with ORPs or PP using the Korea National Insurance Claims Database. Patients were divided into three groups based on the clinical data: (1) patients treated with PP within 30 days of the initiation of treatment (early-PP), (2) patients treated with PP after 30 days of the initiation of therapy (late-PP) and (3) patients treated with only ORPs and not received PP (only-ORP). The primary outcomes were determined as psychiatric rehospitalization during the entire duration of treatment after the first discharge. RESULTS A total of 3790 patients (1096 early-PP, 799 late-PP and 1895 only-ORP) were finally included in the analysis. The mean of number and total length of rehospitalization stays during the entire duration in early-PP group were significantly lower than those of late-PP group and only-ORP group (number: 2.32 stays/year, 3.24 stays/year and 4.23 stays/year, p < .001; total length: 50.34 days/year, 72.26 days/year and 105.14 days/year, p < .001). CONCLUSIONS Early treatment with PP was associated with a greater reduction in psychiatric rehospitalization during the treatment period than late treatment with PP and ORP in schizophrenia.
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Affiliation(s)
- Wonsuk Shin
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Dong Hyeon Lee
- Department of Physiology, CHA University School of Medicine, Seongnam, South Korea
| | - Min-Kyoung Kim
- Department of Psychiatry, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, South Korea
| | - Sang-Hyuk Lee
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.,Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Doo-Yeoun Cho
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry 2021; 8:387-404. [PMID: 33862018 DOI: 10.1016/s2215-0366(21)00039-0] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence of comparative benefits of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics for schizophrenia has been inconsistent across study designs. The aim of this study was to evaluate the comparative benefits of LAIs versus oral antipsychotics in three study designs to inform clinical decision making. METHODS We did a comprehensive systematic review and meta-analysis comparing LAIs versus oral antipsychotics for schizophrenia covering three study designs: randomised controlled trials (RCTs), cohort studies, and pre-post studies. Our literature search was without language restrictions, in MEDLINE and PubMed, the Cochrane Library, Scopus, and Embase, for studies published from database inception up to a last search on March 13, 2020. We also searched for unpublished studies and ClinicalTrials.gov. We included studies lasting at least 6 months that targeted adults with schizophrenia and related disorders (>80% of participants). Studies on penfluridol (neither an LAI or daily oral antipsychotic), case reports, and case series with fewer than 20 patients were excluded. Two investigators independently extracted study-level data and resolved disagreement by consensus, or via a third investigator. Study authors were contacted to obtain additional information as needed. For our primary outcome we meta-analysed the risk ratio (RR) for hospitalisation or relapse with LAIs versus oral antipsychotics by a random-effects model, with hospitalisation used preferentially over relapse. As secondary analyses, we reversed the preferential order to relapse over hospitalisation, and assessed hospitalisation risk and relapse risk individually. Other secondary outcomes included all meta-analysable data, classed by relevance to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, and analysed by study design. Dichotomous outcomes were expressed as pooled RR and continuous outcomes as standardised mean difference (SMD). The protocol is registered with PROSPERO (CRD42019142094). FINDINGS We identified 14 687 records, of which 137 studies (397 319 patients) met the inclusion criteria (32 RCTs [23·4%; 8577 patients], 65 cohort studies [47·4%; 377 447 patients], and 40 pre-post studies [29·2%; 11 295 patients]) and were analysed. The quality of studies in terms of risk of bias varied across study designs and within each study design from low to high. LAIs were associated with a lower risk of hospitalisation or relapse than oral antipsychotics in each of the three study designs (RCTs: 29 studies, 7833 patients, RR 0·88 [95% CI 0·79-0·99], p=0·033; cohort studies: 44 studies, 106 136 patients, RR 0·92 [0·88-0·98], p=0·0044; pre-post studies: 28 studies, 17 876 patients, RR 0·44 [0·39-0·51], p<0·0001). This association was maintained across the study designs when we reversed the preferential order to risk of relapse over hospitalisation, and in individual analysis of hospitalisation risk. The association was maintained only in pre-post studies for relapse risk alone. In all other outcomes related to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, LAIs were more beneficial than oral antipsychotics in 60 (18·3%) of 328 comparisons, not different in 252 (76·8%) comparisons, and less beneficial in 16 (4·9%) comparisons when analysed by study design. Significant heterogeneity was observed across all three study designs. Publication biases were apparent in cohort and pre-post studies, but effect sizes were similar after trim-and-fill analyses. INTERPRETATION Although study designs have strengths and weaknesses, including potential low quality of observational studies, we consistently identified significant benefit with LAIs versus oral antipsychotics in preventing hospitalisation or relapse, in settings ranging from restricted research (RCTs) to real-word application (cohort and pre-post studies). Our findings suggest that increased clinical use of LAIs could improve outcomes in schizophrenia. FUNDING None. TRANSLATIONS For the Chinese, French, German, Italian, Japanese, Portugese and Spanish translations of the abstract see Supplementary Materials section.
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An accidental household outbreak of paliperidone palmitate poisoning via pancake consumption in Lianyungang, China. Western Pac Surveill Response J 2020; 11:1-5. [PMID: 34046235 PMCID: PMC8152821 DOI: 10.5365/wpsar.2019.10.1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction At 11:20 on 26 May 2018, a physician from Lianyungang No. 1 People's Hospital, China, reported that six family members were being treated in the hospital with symptoms from an unknown cause. Methods A case series for a food poisoning investigation and an environmental survey were conducted. The patients and their relatives were interviewed in person with a questionnaire contained on a digital tablet, and an investigation of the patients' home was conducted in the presence of police officers. Probable case and confirmed case were defined to serve as a basis for identifying additional cases. Confirmed cases were defined as those probable cases in which blood, stool or vomitus specimens tested positive for paliperidone palmitate and/or its metabolites. A descriptive analysis was performed. Follow-up by telephone was conducted four months later. Results There were six probable cases. The median age was 35 years (range: 5-76 years). The attack rate was 100% (n = 6/6) of persons who consumed a family dinner, and the hospitalization rate was also 100% (n = 6/6). The median period between exposure and symptom onset was two hours. The main symptoms included vomiting, nausea, drowsiness, dizziness and severe abdominal pain for adults, and vomiting and severe lethargy for children. An 8-year-old girl further showed changes in the ST segment of her electrocardiogram, and a 5-year-old boy showed QT prolongation. The poisoning substance was suspected to be paliperidone palmitate based on the patients' symptoms and epidemiological findings. Discussion We investigated the household food poisoning outbreak through epidemiological analysis and an environmental investigation and determined that it was caused by paliperidone palmitate. The source of the paliperidone palmitate was found to be aluminium containers, taken home by the eldest son who worked at a pharmaceutical company. The containers were sent to a drug disposal centre, and the pharmaceutical company was required to enhance the regulation on the pharmaceutical waste materials to prevent drug poisoning events. By the end of September 2018, the six patients recovered and were released from the hospital, and they did not show any clinical sequelae in four follow-up visits.
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12
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Lee D, Lee BC, Choi SH, Kang DH, Jon DI, Jung MH. Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:303-310. [PMID: 32329310 PMCID: PMC7242100 DOI: 10.9758/cpn.2020.18.2.303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022]
Abstract
Objective Long-acting injectable (LAI) antipsychotics, such as paliperidone palmitate (PP), are known to improve treatment adherence in patients with schizophrenia, which can lead to reductions in relapse and hospitalization rates. However, relatively few studies have demonstrated the economic impact of LAIs, especially in Asian populations. Methods We conducted a claim-based mirror-image study to explore changes in healthcare utilization and associated costs, among 1,272 South Korean patients with schizophrenia (ICD-10-CM code F20), between the 1-year periods before and after the initiation of PP treatment. Results Patients accessed outpatient services more frequently after versus before starting PP treatment, with the number of prescription days increasing by 133.45 (p < 0.0001) and the associated costs increasing by USD 1,497.15 (p < 0.0001). The number of admission days was reduced by 11.33 after starting PP treatment (p < 0.0001) and the associated costs were reduced by USD 1,220.75 (p < 0.0001). However, admission cost savings were different according to patients’ oral drug compliance. The daily dosages for benztropine, procyclidine, and propranolol decreased, showing that there were fewer side-effects after PP-treatment (p < 0.0001). Conclusion Although the high acquisition cost of PP has been regarded as an obstacle to its clinical use, our results imply that the high prescription costs for PP may be counterbalanced by the reduced admission costs associated with its use. Economic outcomes for patients treated with LAIs should be investigated further to help healthcare decision-makers and providers to determine the value of LAIs relative to other treatment medications.
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Affiliation(s)
- Dasom Lee
- Emotional Information and Communication Technology Association, Seoul, Korea
| | - Boung Chul Lee
- Health Insurance Review and Assessment Service, Wonju, Korea.,Department of Psychiatry, Hallym University Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital.,Department of Psychiatry, Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Hyung Kang
- Emotional Information and Communication Technology Association, Seoul, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Myung Hun Jung
- Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
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13
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Mauri MC, Reggiori A, Minutillo A, Franco G, Pace CD, Paletta S, Cattaneo D. Paliperidone LAI and Aripiprazole LAI Plasma Level Monitoring in the
Prophylaxis of Bipolar Disorder Type I with Manic Predominance. PHARMACOPSYCHIATRY 2020; 53:209-219. [DOI: 10.1055/a-1113-7862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Introduction The objective of this study was the evaluation of utility of
plasma level monitoring in the clinical stabilizing efficacy and tolerability of
paliperidone palmitate (PP) vs. aripiprazole monohydrate (AM) in bipolar
disorder I (BD I) with manic predominance.
Methods Fifty-six outpatients of both sexes, age ranging from 18 to 65
years, affected by BD I with manic predominance, orally treated and stabilized
after acute episode for at least 2 weeks with paliperidone or aripiprazole
(n=31, paliperidone; n=25, aripiprazole) underwent a prospective
observational study of switching to the corresponding long-acting injection
(LAI) on the basis of clinical evaluation. The efficacy and tolerability of the
2 treatments were assessed by BPRS, PANSS, HAMD21, and MRS rating scales and a
check list every month for 12 months. Drug plasma levels determinations (PLs)
were performed at the same times.
Results A good clinical stability and tolerability of both drugs were
reported. Lower mean PLs of PP showed a positive effect on depressive symptoms.
AM PLs variability was associated with greater instability of manic symptoms
whereas intermediate PLs seem to have more influence on depressive
symptomatology.
Discussion PLs drug monitoring has been proven to be useful, and further
investigations to identify optimal therapeutic ranges for LAI formulations are
needed.
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Affiliation(s)
- Massimo Carlo Mauri
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Alessandra Reggiori
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Alessandro Minutillo
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Gemma Franco
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Chiara Di Pace
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Silvia Paletta
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milano,
Italy
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Li N, Zhuo JM, Turkoz I, Mathews M, Feng Y, Tan W. A post hoc analysis on hospitalization risk in Asian patients with schizophrenia switching to once-monthly paliperidone palmitate from oral antipsychotics. Expert Opin Pharmacother 2019; 20:2033-2039. [PMID: 31393186 DOI: 10.1080/14656566.2019.1650022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In this post hoc analysis in patients recently diagnosed (≤5 years) with schizophrenia, the effect on hospitalization risk after switching from oral antipsychotic to once-monthly paliperidone palmitate (PP1M) was evaluated. Research design and methods: Change in hospitalization risk following PP1M initiation among patients switching from oral antipsychotics was assessed using prescription sequence symmetry analysis. Hospitalization risk was expressed as an adjusted sequence ratio (ASR) of the number of patients hospitalized prior to PP1M initiation/post PP1M initiation. Cumulative distribution of the time to hospitalization was estimated by the Kaplan-Meier method and symmetry of distribution was assessed using log-rank test. Hazard ratio and 95% CI were calculated using the Cox proportional hazard model. Results: The number of patients hospitalized after switching to PP1M: no change, 203/300 (67.7%); increase, 18/300 (6.0%); and decrease, 79/300 (26.3%). Following PP1M initiation, ASR (95% CI) was 3.56 (2.67, 5.33) suggesting asymmetry and a significant decline in hospitalization risk. Asymmetry in distribution of hospitalization events with significant (p ≤ 0.001) delay in time to hospitalization was also observed. Conclusion: Switching to PP1M treatment from oral antipsychotics is likely to be associated with a significant reduction in hospitalization risk along with a delay in time to hospitalization and rehospitalization.
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Affiliation(s)
- Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing , China
| | - Jian Min Zhuo
- Janssen China Research & Development, Johnson & Johnson (China) Investment Ltd ., Shanghai , China
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Maju Mathews
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Yu Feng
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
| | - Wilson Tan
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
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15
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Mathews M, Gopal S, Nuamah I, Hargarter L, Savitz AJ, Kim E, Tan W, Soares B, Correll CU. Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1365-1379. [PMID: 31190840 PMCID: PMC6535080 DOI: 10.2147/ndt.s197225] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Antipsychotics are the mainstay in schizophrenia management, and long-acting injectable (LAI) antipsychotics contribute to the successful maintenance of treatment by improving non-adherence and preventing relapses. Paliperidone palmitate 3-monthly (PP3M) formulation is the only available LAI antipsychotic that offers an extended 3-month window of stable plasma drug concentration, enabling only four injections per year. This paper summarizes clinically relevant endpoints from available evidence for PP3M to bridge translational research gaps and provide measurable outcomes that can be interpreted in clinical practice. Low number-needed-to-treat (NNT) for relapse prevention (NNT [95% CI] 6-month estimate: 4.8 [3.2; 10.0]; 12-month estimate: 3.4 [2.2; 7.0]), and high number-needed-to-harm (NNH [95% CI] akathisia, 27.1 [12.3; -667.1]; tremor, 80.0 [22.5; 67.3]; dyskinesia, -132.6 [44.5; -23.2]; parkinsonism, 160.0 [28.9; -49.8]) quantify the relative benefits and low propensity for adverse events with PP3M. Symptom remission and reductions in positive and negative symptoms indicate treatment stability. Additionally, meaningful functional remission, reduced dosing frequency, and freedom from daily negotiations favorably impact patient preference and attenuate burdensome aspects of caregiving, representing important healthcare determinants that enhance prospects of treatment continuity in schizophrenia. This information can potentially improve clinicians' judgment of treatment choices, clinical response, and patient selection in routine care. Taken together, PP3M is a valuable antipsychotic treatment option, meriting consideration for a broader role in the long-term management of schizophrenia; its utility should not be limited to patients with poor adherence or when oral antipsychotics have failed.
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Affiliation(s)
- Maju Mathews
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Srihari Gopal
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Isaac Nuamah
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Ludger Hargarter
- Department of Neuroscience, Janssen-Cilag EMEA, Neuss, Deutschland
| | - Adam J Savitz
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Hopewell, NJ, USA
| | - Wilson Tan
- Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Bernardo Soares
- Neuroscience Medical Affairs, Janssen-Cilag, High Wycombe, Buckinghamshire, UK
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, East Garden City, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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16
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Si T, Zhuo J, Feng Y, Lu H, Hong D, Zhang L. Long-term efficacy and safety of paliperidone palmitate once-monthly in Chinese patients with recent-onset schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1685-1694. [PMID: 31303756 PMCID: PMC6603286 DOI: 10.2147/ndt.s191803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The subgroup analysis of a primary study (NCT01051531) evaluated the effect of long-term paliperidone palmitate once-monthly (PP1M) therapy in Chinese patients with recent-onset schizophrenia responding unsatisfactorily to previous oral antipsychotics. Patients and methods: This 18-month, open-label study consisted of 3 phases - screening (7 days), treatment (18 months) and end-of-study/withdrawal visit. All enrolled patients (18-50 years) received PP1M: 150 mg eq. (day 1), 100 mg eq. (day 8) followed by a once-monthly flexible dose (50, 75, 100 or 150 mg eq.). Efficacy and safety were assessed. Results: Among the 118 enrolled Chinese patients, 68 completed the treatment (mean age: 25.6 years; male: 54.7%). A clinically meaningful change from baseline to day 548 was observed in Positive and Negative Syndrome scale (primary endpoint, mean [SD]: -15.3 [20.76]), Personal and Social Performance scale (15.9 [19.65]), Clinician Global Impression-schizophrenia score (-1.2 [1.54]) and Medication Satisfaction Questionnaire score (0.9 [1.73]). Commonly reported treatment-emergent adverse events (TEAEs) included insomnia (13.9%), injection-site pain (13.9%), upper respiratory tract infection (13.0%), restlessness (13.0%) and akathisia (13.0%). Serious TEAEs were reported in 9.3% patients with schizophrenia being most common (6.5%) and one death (suicide) was observed. Conclusion: Efficacy of PP1M corroborate findings from earlier studies and no new safety concerns emerged in this Chinese subgroup of patients with schizophrenia.
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Affiliation(s)
- Tianmei Si
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People's Republic of China.,Peking University Institute of Mental Health/The Sixth Hospital, Beijing, People's Republic of China
| | - Jianmin Zhuo
- Janssen (China) Research & Development Center, Johnson & Johnson (China) Investment Ltd., Shanghai, People's Republic of China
| | - Yu Feng
- Department of Neuroscience, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Huafei Lu
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Di Hong
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Lili Zhang
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
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17
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Su TP, Tang TC, Hsieh MH, Liu CC, Chiu NY, Jang FL, Chiang CL. Long-term safety, efficacy, treatment satisfaction, and impact on healthcare service use of paliperidone palmitate one-month intramuscular formulation in patients with recent-onset schizophrenia in taiwan: A subgroup analysis of an asia-pacific, 18-month, phase 3b study. TAIWANESE JOURNAL OF PSYCHIATRY 2019. [DOI: 10.4103/tpsy.tpsy_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Potaufeu J, Langrée B, Drapier D, Burgot G, Marie N. [Cost-effectiveness study of olanzapine pamoate: Mirror-image analysis after one year]. Encephale 2018; 45:232-238. [PMID: 30579574 DOI: 10.1016/j.encep.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/27/2018] [Accepted: 11/11/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Olanzapine pamoate has a higher cost of treatment than the oral form and requires administration in a hospital setting (unlike other long-acting antipsychotics), and the cost-effectiveness of this treatment may be questioned. Many scientific societies and national health systems are increasingly interested in the pharmacoeconomic impact of health products. The search for efficacy of a treatment can be done in two ways: medico-economic modeling studies or observational studies i.e. randomized controlled trials or mirror studies. The models are based on theoretical models from published clinical data simulating the course and evolution of patient health conditions, which benefit from a particular therapeutic strategy. Even if the design of observational mirror studies makes it possible to get closer to the clinical reality by observing the patient before and after the initiation of the treatment, the majority of the pharmacoeconomic studies published on olanzapine pamoate are modeling works that do not reflect actual conditions of care. The Guillaume Régnier Hospital Center in Rennes has a large cohort of patients treated with olanzapine pamoate: 121 instauration treatments are recorded from April 1, 2010 to Mars 1, 2015. The objective of this study is to evaluate the cost-effectiveness of olanzapine pamoate in actual clinical practice. METHODS This is a one-year cost-effectiveness retrospective observational mirror-image study of a cohort of 52 patients with schizophrenia who were treated for at least three months with olanzapine pamoate. The primary efficacy endpoint is the differential in the number of full-time hospitalizations before and after the introduction of olanzapine pamoate versus the hospital cost differential. The secondary criteria are the difference of the number of the days spent in hospital and the number of outpatient consultations between the year preceding the injection and the year following it. The results were calculated on the general cohort and within 2 subgroups: patients treated for more than one year and those receiving less than one year of treatment with olanzapine pamoate. RESULTS Fifty-two patients were included (median age=35 years, sex ratio H/F=2.7) and only 38.5% discontinued treatment. For patients who maintained long-acting treatment, they received a dosage of 25mg oral olanzapine (min=7.5mg, max=60mg), 5mg more medially than the group having stopped the olanzapine pamoate (20mg; min=10mg, max=40mg). The majority of these patients were receiving off-label authorized marketing doses of oral olanzapine, whereas 22% of them had off-label dosages of olanzapine pamoate. The main causes of discontinuation were symptom persistence, loss of vision and the occurrence of adverse effects (including weight gain and sedation). Olanzapine pamoate significantly reduced the number of hospitalizations compared to the previous management strategy (1 less hospitalization, P<0.001 in patients treated more than one year and in the general cohort). As a logical consequence the number of hospitalization days in day care increased after the establishment of this long-acting antipsychotic with hospital reserve status (18 in median; min=0, max=159). We observed a non-statistically significant tendency of decrease in the number of days of full-time hospitalization and an increase in the number of ambulatory procedures, particularly in patients who have maintained the treatment for one year. This efficiency had a non-significant additional cost of €3361 per year. There was an average multiplication by 8,5 of the drug cost a year later in the general cohort (5.5 in the group of patients treated less than one year and 10.4 in the group of patients who maintained it a year). There was a 23,2% average increase in the cost of hospitalization in the general cohort (3.75 % in patients who maintained treatment compared to 48.9% in patients who discontinued treatment). CONCLUSION By its mirror design, the study was placed in real conditions of care of the patient with schizophrenia. A total of 61.5% of patients maintained treatment with olanzapine pamoate for a minimum of one year. This APAP is more effective without significantly increasing the cost compared to the previous therapeutic strategy (including oral olanzapine). The additional cost is partly due to the administration restriction in a hospital setting in relation to risk of Post-Injection Delirium/Sedation Syndrom (PDSS). There is currently no acceptable efficiency limit. The results of this cost-effectiveness analysis cannot be extrapolated to the other long-acting antipsychotics since it is the only one with hospital reserve status. The current limitations of medico-economics in psychiatry derive from the heterogeneity of clinical forms and the management of mental pathologies.
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Affiliation(s)
- J Potaufeu
- Service de pharmacie, centre hospitalier public du Cotentin, BP 208, 50102 Cherbourg-en-Cotentin, France.
| | - B Langrée
- Service de pharmacie, centre hospitalier Guillaume-Régnier, 108, avenue du Général-Leclerc, 35703 Rennes, France
| | - D Drapier
- EA 4712 comportements et noyaux gris centraux, pôle hospitalo-universitaire de psychiatrie adulte, université de Rennes, centre hospitalier Guillaume-Régnier, 108, avenue du Général-Leclerc, 35703 Rennes, France
| | - G Burgot
- Service de pharmacie, centre hospitalier Guillaume-Régnier, 108, avenue du Général-Leclerc, 35703 Rennes, France
| | - N Marie
- Service de pharmacie, centre hospitalier Guillaume-Régnier, 108, avenue du Général-Leclerc, 35703 Rennes, France
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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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Bioque M, Bernardo M. The current data on the 3-month paliperidone palmitate formulation for the treatment of schizophrenia. Expert Opin Pharmacother 2018; 19:1623-1629. [PMID: 30244607 DOI: 10.1080/14656566.2018.1515915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A three-month injection of paliperidone palmitate (PP3M) has been gradually introduced in the market since 2015. Recently, and due to different reasons, there is an increase in the LAIAs prescription rates, including patients in early phases of psychotic disorders. Areas covered: The following article provides an overview of the antipsychotic market before providing the reader with an overview of the efficacy and tolerability data of the 3-month paliperidone palmitate formulation for the treatment of schizophrenia. The authors take into account the current state of knowledge, as well as the needs not covered by other therapeutic tools at our disposal at this time. Expert opinion: PP3M offers a substantially longer dosing interval than other options, which may be a potential advancement to reduce nonadherence in some patients. Future research, both from randomized controlled trials and large pragmatic studies in real-world settings, will identify which subpopulation and disease stages may obtain greater benefit from this new formulation.
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Affiliation(s)
- Miquel Bioque
- a Barcelona Clínic Schizophrenia Unit , Neuroscience Institute, Hospital Clínic of Barcelona , Barcelona , Spain.,b Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM) , Barcelona , Spain.,c Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Miquel Bernardo
- a Barcelona Clínic Schizophrenia Unit , Neuroscience Institute, Hospital Clínic of Barcelona , Barcelona , Spain.,b Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM) , Barcelona , Spain.,c Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain.,d University of Barcelona , Barcelona , Spain
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21
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Parellada E, Bioque M, Serrano M, Herrera B, García Dorado M. An open-treatment six-week study of the clinical effectiveness of Paliperidone Palmitate in schizophrenia: data from acute units in Spain (SHADOW study). Int J Psychiatry Clin Pract 2018; 22:191-199. [PMID: 29161951 DOI: 10.1080/13651501.2017.1404112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate clinical evolution of patients with schizophrenia admitted in acute units because of a relapse and treated with once-monthly Paliperidone Palmitate (PP1M). METHODS This multicentre, open-label, prospective observational study followed patients with schizophrenia treated with PP1M in acute psychiatric units for up to 6 weeks. RESULTS Out of the 280 enrolled patients, 61 received PP1M as antipsychotic monotherapy, and 219 in combination with other antipsychotics. The average Clinical Global Impression-Schizophrenia (CGI-SCH) score decreased from 4.7 at baseline to 3.3 at final visit (p < .0001); the change was clinically and statistically significant both in patients treated with PP1M in monotherapy and in combination with other antipsychotics. Clear improvements in functioning and high patient satisfaction with the treatment were observed. Time from admission to PP1M therapy initiation correlated with the length of hospital stay (p < .0001); earlier start of PP1M treatment was associated with shorter hospital stay. Adverse events were reported in 7.1% of patients (all non-serious). CONCLUSIONS PP1M was effective and well tolerated in treatment of acute episodes of schizophrenia both in monotherapy and in combination with other antipsychotics in clinical setting. Early start of PP1M therapy in acute schizophrenia episodes might help to shorten hospital stay.
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Affiliation(s)
- Eduard Parellada
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Miquel Bioque
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | | | - Berta Herrera
- c Medical Affairs Department , Janssen-Cilag, S.A , Madrid , Spain
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22
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Si T, Li N, Lu H, Cai S, Zhuo J, Correll CU, Zhang L, Feng Y. Impact of paliperidone palmitate one-month formulation on relapse prevention in patients with schizophrenia: A post-hoc analysis of a one-year, open-label study stratified by medication adherence. J Psychopharmacol 2018; 32:691-701. [PMID: 29764266 PMCID: PMC6024380 DOI: 10.1177/0269881118772449] [Citation(s) in RCA: 11] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited data are available to help identify patients with schizophrenia who are most likely to benefit from long-acting injectable antipsychotics. AIM To investigate the efficacy of long-acting injectable antipsychotic paliperidone palmitate one-month formulation for preventing relapses, factors influencing time to first relapse, and the effect of different antipsychotic adherence levels on time to first relapse in Chinese patients with schizophrenia. METHODS This was a post-hoc analysis from an open-label, single-arm study of stable patients (Positive and Negative Syndrome Scale total score <70; n=367) receiving paliperidone palmitate one-month formulation at the end of an acute 13-week treatment phase, who entered a naturalistic one-year follow-up period, either continuing with flexibly dosed paliperidone palmitate one-month formulation (75-150 mg eq.) or switching to another antipsychotic(s). RESULTS There were 362/367 patients (age=31.4±10.75 years) included in the analysis of time to first relapse (primary outcome) and 327/362 patients (39/327, poor antipsychotic adherence (<80%)) willing to receive antipsychotics were included in the exposure/adherence analysis. Overall, 84.6% (95% confidence interval=79.2-88.7) patients remained relapse-free. Poor adherence during follow-up (hazard ratio=2.97, 95% confidence interval=1.48-5.98, p=0.002) and frequent hospitalizations in the previous year (hazard ratio=1.29, 95% confidence interval=1.02-1.62, p=0.03) were associated with a significant risk of shorter time to first relapse in the univariate analysis. In patients with poor adherence, 'no use' (hazard ratio=13.13, 95% confidence interval=1.33-129.96, p=0.03) and 'interrupted use' (hazard ratio=11.04, 95% confidence interval=1.03-118.60, p=0.047) of paliperidone palmitate one-month formulation (vs continued use) showed a significantly higher risk of relapse; this was not observed in patients with good (≥80%) antipsychotic adherence. No new safety concerns were identified. CONCLUSION Continued use of paliperidone palmitate one-month formulation/long-acting injectable antipsychotic was effective in preventing schizophrenia relapses, especially in patients with suboptimal antipsychotic adherence.
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Affiliation(s)
- Tianmei Si
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental Health, Ministry of Health, Beijing, People’s Republic of China,Institute of Mental Health/the Sixth Hospital, Peking University, Beijing, People’s Republic of China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Huafei Lu
- Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Shangli Cai
- Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Jianmin Zhuo
- Johnson & Johnson (China) Investment Ltd, Shanghai, People’s Republic of China
| | - Christoph U Correll
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, USA,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Lili Zhang
- Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Yu Feng
- Janssen Pharmaceutical Companies, Johnson and Johnson, Singapore,Yu Feng, Janssen Pharmaceutical Companies of Johnson and Johnson, Ascent, 2 Science Park Drive, Singapore Science Park 1, Singapore 118222, Singapore.
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Real-world data on paliperidone palmitate for the treatment of schizophrenia and other psychotic disorders: a systematic review of randomized and nonrandomized studies. Int Clin Psychopharmacol 2018; 33:15-33. [PMID: 28817397 DOI: 10.1097/yic.0000000000000195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a systematic review of the effects of 1-month paliperidone palmitate (PP1M) for the treatment of schizophrenia and related psychotic disorders in terms of outcomes reported in real-world evidence studies. A systematic review of real-world randomized and nonrandomized studies with PP1M was performed and is reported according to PRISMA guidelines. Comparative effectiveness data with oral antipsychotics indicate that PP1M has a lower likelihood of relapse-related events, including rehospitalization, and these differences are clinically relevant. A randomized, double-blind study showed that PP1M has no advantage over haloperidol decanoate in the time to treatment failure. Although there was a marked variability across studies, PP1M was not superior to other antipsychotics in terms of study completion rates. Pharmacoeconomic data show that, during a follow-up period of 12 months, the mean total healthcare cost was not significantly different in patients treated with PP1M compared with those receiving oral antipsychotics. The mean maximum prolactin levels were significantly higher with PP1M than with haloperidol decanoate; however, neither drug differs in the frequency of prolactin-related adverse events. Results on prolactin-related adverse events were inconsistent in two randomized comparisons with oral antipsychotics and were not reported in a randomized comparison with aripiprazole. There were no significant differences between haloperidol decanoate and PP1M in the severity of abnormal involuntary movements and parkinsonism, or in the incidence of tardive dyskinesia; however, patients treated with haloperidol decanoate showed greater worsening of akathisia and required treatment for parkinsonism and akathisia significantly more frequently than patients who received PP1M. In conclusion, real-world data that originate from both pragmatic randomized clinical trials and observational studies indicate that PP1M is superior to oral antipsychotics in delaying the time to relapse or treatment failure. Furthermore, the pharmacoeconomic data reviewed for this article suggest that the advantages of PP1M compared with oral antipsychotics are not associated with an increased total cost for healthcare providers.
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Emsley R, Kilian S. Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatr Dis Treat 2018; 14:205-223. [PMID: 29379293 PMCID: PMC5759847 DOI: 10.2147/ndt.s139633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The course of schizophrenia is characterized by multiple relapses, incomplete remission of symptoms, enduring cognitive deficits, and social and occupational functional impairments. Nonadherence to antipsychotic medication is a major determinant of this poor outcome. Long-acting injectable antipsychotics were developed specifically to address the nonadherence problem and are increasingly considered as an early treatment option, in an attempt to prevent accruing morbidity. This review focuses on paliperidone palmitate, the long-acting injectable (LAI) formulation of paliperidone. After considering the pharmacology of paliperidone palmitate, we review the randomized controlled trials, as well as pertinent observational, pragmatic studies for paliperidone once-monthly injections in schizophrenia. Finally, we review the recently introduced 3-monthly formulation of paliperidone palmitate. Taken together, the studies indicate that paliperidone palmitate (PP) has good efficacy compared with placebo and comparable with other antipsychotics including risperidone. The tolerability profile of PP is similar to that of risperidone, with the most important side effects being prolactin elevation, weight gain, and extrapyramidal symptoms. Advantages of PP include the extensive research database and clinical experience with paliperidone and its parent compound risperidone, the availability of different LAI formulations (once-monthly, 3-monthly, and perhaps even longer acting formulations in future), and the novel dose initiation procedure that provides rapid onset of action without the need for oral antipsychotic supplementation.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Li H, Li Y, Feng Y, Zhuo J, Turkoz I, Mathews M, Tan W. Impact of time of initiation of once-monthly paliperidone palmitate in hospitalized Asian patients with acute exacerbation of schizophrenia: a post hoc analysis from the PREVAIL study. Neuropsychiatr Dis Treat 2018; 14:1107-1117. [PMID: 29731633 PMCID: PMC5927347 DOI: 10.2147/ndt.s157399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the differences in efficacy and safety outcomes in acute exacerbating schizophrenia patients between 2 subgroups (≤1 week and >1 week), differing in time interval from hospitalization to time of initiation of once-monthly paliperidone palmitate. PATIENTS AND METHODS PREVAIL was a multicenter, single-arm, open-label, prospective Phase IV study in hospitalized Asian patients (either sex, aged 18-65 years) diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Change from baseline to week 13 in primary (Positive and Negative Syndrome Scale [PANSS] total score), secondary endpoints (PANSS responder rate, PANSS subscale, PANSS Marder factor, Clinical Global Impression-Severity, and Personal and Social Performance scale scores, readiness for hospital discharge questionnaire) and safety were assessed in this post hoc analysis. RESULTS Significant mean reduction from baseline to week 13 in the PANSS total score, 30% PANSS responder rates (P≤0.01), PANSS subscales (positive and general psychopathology; all P≤0.01), PANSS Marder factor (positive symptoms, uncontrolled hostility, and excitement and anxiety/depression; all P≤0.01), Personal and Social Performance scale scores (P≤0.05) and Clinical Global Impression-Severity categorical summary (P≤0.05) were significantly greater in the ≤1 week subgroup versus >1 week subgroup (P≤0.05). The readiness for hospital discharge questionnaire improved over time for the overall study population, but remained similar between subgroups at all-time points. Treatment-emergent adverse events were similar between the subgroups. CONCLUSION Early initiation of once-monthly paliperidone palmitate in hospitalized patients with acute exacerbation of schizophrenia led to greater improvements in psychotic symptoms with comparable safety than treatment initiation following 1 week of hospitalization.
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Affiliation(s)
- Huafang Li
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yan Li
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yu Feng
- Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Jianmin Zhuo
- Janssen China Research and Development, Shanghai, China
| | | | - Maju Mathews
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Wilson Tan
- Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
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Tompsett T, Masters K, Donyai P. The utility of novel outcome measures in a naturalistic evaluation of schizophrenia treatment. Neuropsychiatr Dis Treat 2018. [PMID: 29535524 PMCID: PMC5841343 DOI: 10.2147/ndt.s151174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A number of naturalistic studies have investigated paliperidone palmitate (PP) using proxy measures of effectiveness. An unexplored option is to examine the utility of the mental health clustering tool (MHCT), which is used in UK clinical practice to measure patient well-being and is linked to allocation of resources. This study evaluated the effectiveness of PP using the MHCT, the Health of the Nation Outcome Scales (HoNOS), and, for comparison, more conventional outcome measures. METHODS This was a naturalistic, 1-year evaluation of PP (n=50) in schizophrenia as well as a comparator antipsychotic drugs group. Changes in the MHCT cluster-score cost ranking and four HoNOS-derived factors were analyzed using a mixed-model statistical analysis to explore the utility of these measures. RESULTS At 1 year, 30 patients (60%) continued PP treatment. The mean "cluster-score cost ranking" (-1.5) and Severe Disturbance factor scores (-1.1) were significantly lower (p-value [adjusted] =0.0003, p-value [adjusted] =0.002, respectively) after 1 year of antipsychotic treatment but no differences were found between PP and the comparator antipsychotic drugs group. Patients prescribed PP were 1.8 times (95% CI 1.1-3.1) more likely to be discharged from hospital than those in the comparator antipsychotic drugs group. CONCLUSION PP's continuation rate after 1 year made the study similar to the existing evaluations, and it was possible to prospectively evaluate antipsychotic effectiveness using the novel measures although these did not discriminate between PP and the comparator group. The investigation illustrates that in principle these novel measures are meaningful in naturalistic study designs.
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Affiliation(s)
| | - Kate Masters
- Department of Pharmacy, University of Reading, Reading, UK.,Department of Pharmacy, Berkshire Healthcare NHS Foundation Trust, Reading, UK
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Mathews M, Nuamah I, Savitz AJ, Hough DW, Najarian D, Kim E, Gopal S. Time to onset and time to resolution of extrapyramidal symptoms in patients with exacerbated schizophrenia treated with 3-monthly vs once-monthly paliperidone palmitate. Neuropsychiatr Dis Treat 2018; 14:2807-2816. [PMID: 30498351 PMCID: PMC6207222 DOI: 10.2147/ndt.s175364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety of 3-monthly paliperidone palmitate (PP3M) vs once-monthly paliperidone palmitate (PP1M) treatment with regard to extrapyramidal symptom (EPS)-related treatment-emergent adverse events (TEAEs) in patients with schizophrenia, previously stabilized on PP1M treatment. PATIENTS AND METHODS Data on overall incidence, time to onset (TTO), and time to resolution (TTR) of EPS-related TEAEs (overall, subclasses such as dyskinesia, dystonia, hyperkinesia, parkinsonism, and tremor) from a randomized double-blind (DB) non-inferiority study were compared between PP3M and PP1M. Subgroup analysis was performed by age (18-25, 26-50, and 50+ years) and final open-label (OL) dose (50/75, 100, and 150 mg eq.). RESULTS Overall incidence of spontaneously reported EPS-related TEAEs decreased from 12.6% (PP1M) in OL phase to 8.3% (PP3M) and 7.4% (PP1M) in the DB phase; overall median TTO and TTR values were comparable between both groups. Among patients with reported EPS-related TEAEs, the median TTO for all EPS-related TEAEs was 17 days (PP1M) in OL phase and 115 days (PP3M) and 98.5 days (PP1M) in DB phase; median TTR was 36.5 days (PP1M) in OL phase and 91 days (PP3M) and 85.5 days (PP1M) in DB phase. No clear dose- or age-related differences in TTO and TTR of EPS-related TEAEs were noted. CONCLUSION Despite differences in apparent half-life and pharmacokinetic profiles (peak plasma exposure of PP3M formulation is 70% higher than that of PP1M formulation), both PP3M and PP1M formulations exhibited comparable incidence of EPS-related TEAEs, TTO, and TTR in patients with schizophrenia.
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Affiliation(s)
- Maju Mathews
- Janssen Research and Development, LLC, Titusville, NJ, USA,
| | - Isaac Nuamah
- Janssen Research and Development, LLC, Titusville, NJ, USA,
| | - Adam J Savitz
- Janssen Research and Development, LLC, Titusville, NJ, USA,
| | - David W Hough
- Janssen Research and Development, LLC, Titusville, NJ, USA,
| | - Dean Najarian
- Janssen Scientific Affairs, Titusville, LLC, NJ, USA
| | - Edward Kim
- Janssen Scientific Affairs, Titusville, LLC, NJ, USA
| | - Srihari Gopal
- Janssen Research and Development, LLC, Titusville, NJ, USA,
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Si T, Zhuo J, Turkoz I, Mathews M, Tan W, Feng Y. Once-monthly injection of paliperidone palmitate in patients with recently diagnosed and chronic schizophrenia: a post-hoc comparison of efficacy and safety. Expert Opin Pharmacother 2017; 18:1799-1809. [PMID: 29141463 DOI: 10.1080/14656566.2017.1401608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The use of long-acting injectable antipsychotics in recently diagnosed schizophrenia remains less explored. We evaluated the efficacy and safety of paliperidone palmitate once-monthly (PP1M) treatment in adult patients with recently diagnosed vs. chronic schizophrenia. RESEARCH DESIGN AND METHODS These post-hoc analyses included two multicenter studies. Study 1 (NCT01527305) enrolled recently diagnosed (≤5 years) and chronic (>5 years) patients; Study 2 (NCT01051531) enrolled recently diagnosed patients only. Recently diagnosed patients were further sub-grouped into ≤2 years or 2-5 years. The primary efficacy endpoint was the change from baseline in Positive and Negative Syndrome Scale (PANSS) total score. RESULTS In Study 1, 41.5% patients had recent diagnosis (≤2 years: 56.8%; 2-5 years: 43.2%); 58.5% had chronic schizophrenia. In Study 2, 52.8% and 47.2% patients were grouped into ≤2 years and 2-5 years, respectively. PANSS total score showed significantly greater improvement in patients with recently diagnosed vs. chronic schizophrenia. Similar results were obtained for PANSS responder rate, improvements in PANSS, and CGI-S scores. CONCLUSION PP1M was efficacious in both recently diagnosed and chronic schizophrenia, with the benefits being more pronounced in patients with recently diagnosed schizophrenia. This adds to growing evidence recommending long-acting antipsychotic interventions at early stages of schizophrenia.
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Affiliation(s)
- Tianmei Si
- a National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/Institute of Mental Health) and the Key Laboratory of Mental Health, Ministry of Health , Beijing , People's Republic of China
| | - Jianmin Zhuo
- b Janssen Research and Development , Shanghai , People's Republic of China
| | - Ibrahim Turkoz
- c Janssen Research and Development, LLC , Titusville , NJ , USA
| | - Maju Mathews
- c Janssen Research and Development, LLC , Titusville , NJ , USA
| | - Wilson Tan
- d Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore
| | - Yu Feng
- d Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore
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Paliperidone Palmitate Improves and Maintains Functioning in Asia-Pacific Patients with Schizophrenia. Adv Ther 2017; 34:2503-2517. [PMID: 29101715 PMCID: PMC5702374 DOI: 10.1007/s12325-017-0638-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 12/03/2022]
Abstract
Introduction Post hoc analyses (two single-arm studies) were conducted to determine the impact of once-monthly injection of paliperidone palmitate on functioning in adult patients with schizophrenia in the Asia–Pacific region. Methods Study 1 enrolled hospitalized patients with acute exacerbation of schizophrenia, and study 2 enrolled patients with recently diagnosed schizophrenia unsatisfactorily treated with oral antipsychotics. Patients received paliperidone palmitate, 150 mg eq. on day 1, 100 mg eq. on day 8, then once monthly (50–150 mg eq.) (study 1, days 36 and 64; study 2, 18 months). Functional status was evaluated by Personal and Social Performance score in both studies and employment only in study 2. Results In study 1, 54 of 184 patients (29.4%) with an unfavorable level of functioning at the baseline improved to a favorable level (Personal and Social Performance score greater than 70) at day 92. This improvement was significantly greater among patients with recently diagnosed schizophrenia (5 years or less) compared with patients with chronic schizophrenia (more than 5 years): 40% versus 22% (p < 0.0001). Improvements were observed in all four domains (socially useful activities, personal and social relationships, self-care, disturbing/aggressive behavior). In study 2, significant (p < 0.0001) improvement in functioning was observed at all visits, beginning at week 5. Almost half (48.7%, 247/507) of patients showed clinically meaningful improvement in functioning (i.e., 10 point or greater increase in Personal and Social Performance score) at month 18. The proportion of patients fully/partially employed was greater at all postbaseline visits (134 of 280, 47.9%, at month 18) as compared with the baseline. Conclusion Functioning, including employment, was improved after short-term, once-monthly paliperidone palmitate injection, and was sustained to 18 months in Asia–Pacific patients with schizophrenia. Funding Janssen-Cilag Asia–Pacific Medical Affairs.
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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.
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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
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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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Mauri MC, Reggiori A, Paletta S, Di Pace C, Altamura AC. Paliperidone for the treatment of schizophrenia and schizoaffective disorders - a drug safety evaluation. Expert Opin Drug Saf 2017; 16:365-379. [PMID: 28140680 DOI: 10.1080/14740338.2017.1288716] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Paliperidone, the major active metabolite of risperidone, is a second-generation antipsychotic that has been developed as an extended-release (ER) oral formulation and a long-acting injectable paliperidone palmitate (PP) formulation. Paliperidone has demonstrated efficacy in the reduction of acute schizophrenia symptoms and clinical benefits were maintained also in the long-term treatments. Paliperidone ER and PP are generally well tolerated with a predictable adverse event profile. Areas covered: Data from studies evaluating safety and tolerability in the acute and maintenance treatment of schizophrenia with paliperidone are reviewed. The reported treatment-emergent adverse events of these formulations are discussed. Expert opinion: In the treatment of schizophrenia and schizoaffective disorders the safety profile has a central role because it can enhance patient compliance. In fact treatment-emergent adverse events are one of the main causes of discontinuation in these patients. In particular the main limitation in the administration of paliperidone could be represented by the onset of hyperprolactinemia (especially in women) and of mild parkinsonism. Paliperidone has a high impact on current long-term drug strategies, especially given the new 3 month long-acting injectable formulation of PP.
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Affiliation(s)
- M C Mauri
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - A Reggiori
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - S Paletta
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - C Di Pace
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - A C Altamura
- a Department of Neuroscience and Mental Health, Clinical Psychopharmacology Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
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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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Kim E, Correll CU, Mao L, Starr HL, Alphs L. Once-monthly paliperidone palmitate compared with conventional and atypical daily oral antipsychotic treatment in patients with schizophrenia. CNS Spectr 2016; 21:466-477. [PMID: 27629292 DOI: 10.1017/s1092852916000444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This analysis of the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study (NCT01157351) compared outcomes after administration of once-monthly paliperidone palmitate (PP) vs conventional oral antipsychotics (COAs) or atypical oral antipsychotics (AOAs). METHODS PRIDE was a 15-month study of 444 individuals with schizophrenia and a history of incarceration. They were randomly assigned to PP or to 1 of 7 commonly prescribed OAs. Primary endpoint was time to first treatment failure (TF). Event-free probabilities were estimated using the Kaplan-Meier method; treatment group differences (PP vs COAs, PP vs AOAs, and PP vs oral paliperidone/risperidone) were assessed using a log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. No adjustment was made for multiplicity. RESULTS Compared with PP, risk for first TF was 34% higher with COAs (HR: 1.34; 95% CI: 0.80-2.25), 41% higher with AOAs (HR: 1.41; 95% CI: 1.06-1.88), and 39% higher with paliperidone/risperidone (HR: 1.39; 95% CI: 0.97-1.99). Incidences of extrapyramidal symptom-related adverse events (AEs) were 45.7%, 13.7%, and 10.6% in the COA, AOA, and oral paliperidone/risperidone groups vs 23.9% in the PP group. Incidences of prolactin-related AEs were 5.7%, 3.8%, and 3.5% vs 23.5%, and incidences of ≥7% weight increase were 11.4%, 14.9%, and 16.0% vs 32.4%. CONCLUSIONS Results suggest a lower risk of TF but a higher rate of some AEs after treatment with PP vs COAs, AOAs, and paliperidone/risperidone. Deselection of specific OAs and low patient-compliance rates with OAs likely biased the safety results.
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Affiliation(s)
- Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Christoph U Correll
- Hofstra Northwell School of Medicine, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Lian Mao
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
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Barriers to the use of long-acting injectable antipsychotics in schizophrenia may be overcome by implementing a variety of strategies. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0345-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Schizophrenia and related disorders remain major disabling conditions, mainly due to antipsychotic treatment resistance and to relapses related to antipsychotic nonadherence. Treatment nonadherence rates are consistently high in long-term patients, but also in first-episode patients with schizophrenia. Long-acting injectable antipsychotics (LAIAs) were mainly developed to improve adherence to treatment and to reduce the rate of relapse and rehospitalization in schizophrenia due to treatment discontinuation. There is favorable clinical evidence, in terms of both efficacy and treatment adherence, that could support higher LAIA prescription rates, especially in patients in early phases of psychotic disorders. Several factors could be hindering wider use of LAIAs, mainly associated with perceptions and attitudes of patients, clinicians, and health managers or policy makers. The main aims of this review are (i) to summarize the existing data on the efficacy and tolerability of LAIAs compared with oral formulations in the management of schizophrenia and related disorders, focusing on the novel, second-generation LAIA options; (ii) to analyze the barriers that exist to the more widespread use of these formulations; and (iii) to discuss possible approaches to overcoming these barriers.
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Pietrini F, Spadafora M, Tatini L, Talamba GA, Andrisano C, Boncompagni G, Manetti M, Ricca V, Ballerini A. LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment. Eur Psychiatry 2016; 37:35-42. [PMID: 27442981 DOI: 10.1016/j.eurpsy.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects. METHODS Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1). RESULTS Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period. CONCLUSIONS Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- F Pietrini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy.
| | - M Spadafora
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - L Tatini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - G A Talamba
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - C Andrisano
- Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
| | - G Boncompagni
- Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
| | - M Manetti
- Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
| | - V Ricca
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - A Ballerini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
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Bernardo M, Bioque M. Three-month paliperidone palmitate - a new treatment option for schizophrenia. Expert Rev Clin Pharmacol 2016; 9:899-904. [DOI: 10.1080/17512433.2016.1191945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Carpiniello B, Pinna F. Critical appraisal of 3-monthly paliperidone depot injections in the treatment of schizophrenia. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1731-42. [PMID: 27307704 PMCID: PMC4887041 DOI: 10.2147/dddt.s86301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims Three-monthly injections of paliperidone palmitate (PP-3M) represent a new and recently introduced long-acting antipsychotic therapeutic option. This review focuses on available data relating to the efficacy and safety of PP-3M and its position in the current therapeutic scenario. Method An analysis of PubMed, Scopus, and ISI Web of Knowledge databases was conducted, and all available papers on PP-3M, including poster presentations, were selected and considered for the purpose of the present review. Findings: to date, three full papers have been published, the first, a Phase 1 randomized, open label study investigating the pharmacokinetics, safety, and tolerability of the drug; the second, a Phase 3 double blind study vs placebo focusing on efficacy and tolerability; and the last relating to the practical use of PP-3M. The five posters identified describe data reported in the above-cited papers. Overall, the pharmacokinetic findings obtained in these studies highlight the feasibility of administering PP-3M on a 3-monthly basis, subsequent to the administration of four 1-monthly injections of PP at doses 3.5 times higher than the stabilized dose of 1-monthly injections of PP (ie, 175, 300, 450, and 525 mgs). The published studies highlight a significantly longer time to relapse compared to placebo, and significantly better results compared to placebo for all secondary end-points (Positive and Negative Syndrome Scale, Clinical Global Impression-Severity Scale, Personal and Social Performance Scale scores), in addition to reasonably good safety and tolerability profiles. Conclusion PP-3M emerges as a potential candidate for use as a first-line long-acting agent in the maintenance treatment of patients with schizophrenia. Further studies should however be conducted to confirm this expectation. In view of its efficacy, tolerability, and safety, together with the longer timespan between injections, PP-3M currently represents one of the best available options, and may contribute towards addressing the issue of poor adherence, even in early psychosis.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine - Psychiatry Research Unit and Psychiatric Clinic, University Hospital, Cagliari, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine - Psychiatry Research Unit and Psychiatric Clinic, University Hospital, Cagliari, Italy
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Di Lorenzo R, Cameli M, Bolondi M, Landi G, Moretti V, Piemonte C, Pollutri G. Paliperidone Palmitate Treatment in Outpatient Care Setting: A Naturalistic Study. PSYCHOPHARMACOLOGY BULLETIN 2016; 46:36-53. [PMID: 27738372 PMCID: PMC5044485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate paliperidone palmitate (PP) effectiveness, safety and adherence to treatment. METHODS We collected data of all patients (n = 50) affected by Schizophrenia Disorders, treated with PP for a 3 month minimum period in the outpatient setting of Mental Health Department in Modena, from 01/01/2014 to 31/01/2015. We evaluated reasons and modality for PP implementation, improvement in symptom and functioning scales, adverse effects, discontinuations and relapses. We statistically correlated socio-demographic and clinical variables of our sample with PP therapeutic variables. RESULTS We registered an improvement in all scales, with a superior percentage in PANSS positive subscale. The mean PP dose in some patients was lower than official indications, although our sample was clinically severe. Illness relapses affected 60% and dropout 18% of patients. PP was well tolerated and in just a few cases adverse events required treatment interruption. The risk factors for discontinuation were represented by "lack of therapeutic compliance" (HR = 4.11, p < 0.0001) and "inefficacy" (HR = 1.67, p < 0.0001). CONCLUSIONS With limitations of observational design, this research highlights that PP was well tolerated and effective in improving both psychotic symptoms and functioning, but moderately effective in preventing relapse, probably due to clinical severity of our patients associated with extremely cautious and flexible PP prescriptions.
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Affiliation(s)
- Rosaria Di Lorenzo
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Michela Cameli
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Marisa Bolondi
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Giulia Landi
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Valentina Moretti
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Chiara Piemonte
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
| | - Gabriella Pollutri
- Dr. Di Lorenzo, MD, Psychiatrist, SPDC c/o NOCSAE, via P. Giardini, 1355, 41126 Baggiovara (Modena), Mental Health Department, Az-Usl, Modena, Italy. Dr. Cameli, MD, Psychiatrist, Private accredited psychiatric hospital, Villa Maria Luigia, via Montepelato Nord, 41, 43022 Monticelli Terme (PR), Italy. Drs. Bolondi, MD, Landi, MD, Piemonte, MD, Pollutri, MD, Residents in Psychiatry, University of Modena and Reggio Emilia, via del Pozzo, 71, 41224 Modena, Italy. Dr. Moretti, MD, Psychiatrist, Centro Salute Mentale, via Mandriolo Superiore, 11, 42015 Correggio, AzUsl Reggio Emilia, Italy
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Li H, Turkoz I, Zhang F. Efficacy and safety of once-monthly injection of paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatr Dis Treat 2016; 12:15-24. [PMID: 26730193 PMCID: PMC4694691 DOI: 10.2147/ndt.s83651] [Citation(s) in RCA: 14] [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] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION This single-group, open-label, prospective, noncomparative, multicenter, Phase IV study explored the efficacy and tolerability of paliperidone palmitate (PP) in hospitalized patients with acute exacerbation of schizophrenia. METHODS Asian patients of either sex, between 18 and 65 years of age, diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) with acute exacerbations within the previous 4 weeks, were enrolled. Intramuscular PP was initiated at doses of 150 milligram equivalent (mg eq) (day 1) and 100 mg eq (day 8), followed by a monthly maintenance dose between 75 mg eq and 150 mg eq (days 36 and 64). Primary efficacy endpoint was the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score (last-observation-carried-forward) at week 13. RESULTS Of the 212 enrolled patients, 152 (71.7%) completed the 13-week treatment; withdrawal of consent (24 [11.3%] patients) was the most common reason for study discontinuation. Mean (standard deviation) PANSS total score from baseline (90.0 [17.41]) improved significantly at day 4 (-6.1 [9.27]; 95% confidence interval: -7.38, -4.85; P<0.001) and week 13 endpoint (-23.9 [23.24]; 95% confidence interval: -27.10, -20.78; P<0.001). Similarly, the secondary endpoints (Clinical Global Impression-Severity, Physical and Social Performance, each PANSS subscale, and Marder factor scores) improved significantly from baseline to week 13 endpoint (P<0.001 for all). At week 13, 112/210 (53.3%) patients had a 40% improvement in the PANSS total score (responder rate), and 133/212 (62.7%) patients were ready for hospital discharge. Overall, 139 (65.6%) patients experienced at least one treatment-emergent adverse event (TEAE). Most common (>5%) TEAEs were hyperprolactinemia, constipation, nasopharyngitis, insomnia, increased weight, and tremor. Worsening of schizophrenia (3.3%) and sinus bradycardia (2.0%) were serious TEAEs; no deaths were reported. CONCLUSION PP was generally tolerable and efficacious in a hospital setting for the treatment of acute exacerbated schizophrenia with significant improvements in psychotic symptoms, social functioning, and severity of illness.
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Affiliation(s)
- HuaFang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Fan Zhang
- Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
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Zhang L, Li J, Zhao Y, Su Y, Si T. Critical evaluation of paliperidone in the treatment of schizophrenia in Chinese patients: a systematic literature review. Neuropsychiatr Dis Treat 2016; 12:113-31. [PMID: 26811684 PMCID: PMC4714741 DOI: 10.2147/ndt.s64672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Paliperidone (9-hydroxyrisperidone), the major active metabolite of risperidone, has been introduced as a novel atypical antipsychotic agent in many countries. It is available both as an oral extended-release (ER) formulation and as a long-acting injection (paliperidone palmitate, PP), which have been approved for treating schizophrenia in the People's Republic of China since 2009 and 2012, respectively. This systematic review summarizes the efficacy, effectiveness, and safety of paliperidone in the treatment of schizophrenia in the Chinese population. METHODS A systematic literature search was conducted on the databases covering international and Chinese core journals, published from January 1, 2008, to May 22, 2015. RESULTS A total of 122 publications were retrieved, of which 63 studies were identified for inclusion; most studies were related to paliperidone ER (n=53), nine were related to PP, and one study was related to both agents. Paliperidone ER demonstrated at least comparable efficacy with active comparators, including risperidone, olanzapine, ziprasidone, or aripiprazole, and was found to be superior with respect to the onset of action and improvement in the Personal and Social Performance Scale score. Paliperidone ER appeared to be associated with a lower risk of metabolic syndromes; the most common treatment-emergent adverse events were extrapyramidal symptoms, akathisia, insomnia, and somnolence. Results from interventional and observational studies showed that PP was also an effective and well-tolerated treatment for Chinese patients with schizophrenia. The findings were generally consistent with those observed in non-Chinese populations. CONCLUSION Both paliperidone ER and PP were effective and well-tolerated agents for the treatment of schizophrenia in the Chinese population according to the data we reviewed. No new safety signals specific for the Chinese population were raised for paliperidone. Further studies may be needed to collect more data on long-term treatment of schizophrenia in the People's Republic of China.
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Affiliation(s)
- LiLi Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
| | - JiTao Li
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - YanJie Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yun'Ai Su
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
| | - Tianmei Si
- National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China; Peking University Sixth Hospital, Institute of Mental Health, Beijing, People's Republic of China; The Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, People's Republic of China
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González-Rodríguez A, Catalán R, Penadés R, Garcia-Rizo C, Bioque M, Parellada E, Bernardo M. Profile of paliperidone palmitate once-monthly long-acting injectable in the management of schizophrenia: long-term safety, efficacy, and patient acceptability - a review. Patient Prefer Adherence 2015; 9:695-706. [PMID: 26082620 PMCID: PMC4459629 DOI: 10.2147/ppa.s63948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Short-term studies focused on once-monthly paliperidone palmitate (PP) at doses of 25 mg eq, 50 mg eq, 75 mg eq, 100 mg eq, or 150 mg eq have shown its efficacy and tolerability in the treatment of schizophrenia patients. However, few open-label and long-term studies are available regarding this new pharmacological formulation. Thus, our main aim was to review the scientific evidence on efficacy, safety, tolerability, and preference of PP in these populations. METHOD Electronic searches were conducted by using PubMed and ISI Web of Knowledge databases. All relevant studies published from 2009 until January 2015 were included without any language restriction if patients met diagnostic criteria for schizophrenia, and adequate information on efficacy, safety, and tolerability of once-monthly PP was available. RESULTS Nineteen studies were identified irrespective of the study design and duration of the follow-up period. Randomized, double-blind, placebo-controlled trials found that schizophrenia patients receiving PP showed a significant improvement in psychotic symptoms and similar adverse events compared to placebo and suggested that all doses of PP were efficacious and well tolerated. Other studies demonstrated noninferiority of PP compared to risperidone long-acting injectable in recently diagnosed schizophrenia patients, chronically ill patients, as well as in acute and nonacute symptomatic schizophrenia patients, and a similar proportion of treatment-emergent adverse events between both groups were also noted. CONCLUSION Several studies have demonstrated that schizophrenia patients treated with PP show higher rates of improvement of psychotic symptoms compared to placebo, and similar efficacy and tolerability outcomes were noted when comparing PP to risperidone long-acting injectable or oral, paliperidone extended release.
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Affiliation(s)
- Alexandre González-Rodríguez
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Correspondence: Rosa Catalán, Barcelona Clínic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clínic of Barcelona, 170, Villarroel Street, 08036 Barcelona, Spain, Tel +34 93 227 5400, Email
| | - Rafael Penadés
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Pharmacology, University of Barcelona, Barcelona, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Chiou CF, Wang BC, Caldwell R, Furnback W, Lee JS, Kothandaraman N, Lee S, Wang J, Zhang F. The cost reduction in hospitalization associated with paliperidone palmitate in the People's Republic of China, Korea, and Malaysia. Neuropsychiatr Dis Treat 2015; 11:1989-94. [PMID: 26346330 PMCID: PMC4531005 DOI: 10.2147/ndt.s86722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Schizophrenia results in substantial health care utilization costs. Much of these costs can be attributed to health care use resulting from nonadherence to treatment, relapse, and hospitalization. AIMS OF THE STUDY The objective of this research is to further estimate the health care resource utilization costs of patients with schizophrenia in the People's Republic of China, Korea, and Malaysia with a specific focus on the reduction in hospitalization costs associated with the use of long-acting, injectable paliperidone palmitate (PP) relative to alternative treatment medications. METHODS The study focuses exclusively on the estimated reduction in hospitalization days following treatment with PP and the potential associated cost savings. Cost analysis was done using a payer's perspective and only includes direct health care costs associated with hospitalization. Localized cost data were taken from published sources, and health care utilization was estimated based on a clinical study conducted in countries in the Asia-Pacific region. People's Republic of China, Korea, and Malaysia had the highest number of patients enrolled in the clinical study, and thus were chosen for this research. Analysis looked at 12-month and 18-month periods following initial treatment with PP relative to a retrospective 12-month period utilizing alternative treatment medications. RESULTS Results suggest that reductions in hospital utilization cost over 12 months may occur through the use of PP relative to alternatives-ranging from $1,991 for the People's Republic of China to $6,698 for Korea and $6,716 for Malaysia. CONCLUSION Given the substantial costs associated with the treatment of schizophrenia both worldwide and in Asia, it is important to fully understand the costs and outcomes associated with various treatment options. In this research, we have specifically analyzed the direct health care cost savings associated with hospital utilization for patients taking PP relative to alternative treatment methods. The results suggest that reductions in hospital utilization cost were associated with PP treatment, likely largely due to increased adherence to treatment.
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Affiliation(s)
| | | | - Ronald Caldwell
- Department of Economics, University of Michigan, Ann Arbor, MI, USA
| | | | - Jung-Sun Lee
- Department of Psychiatry, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | - Jin Wang
- Strategy and Development, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
| | - Fan Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
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