Relationship between clinical outcomes measures and personal and social performance functioning in a prospective, interventional study in schizophrenia

OBJECTIVES

To explore clinical and demographic characteristics impacting patient functioning by determining extent of overlap in factors driving change in Personal and Social Performance (PSP) and other clinical outcomes.

METHODS

Post-hoc analysis from a single-arm trial of paliperidone extended release in adult patients with nonacute symptomatic schizophrenia. Psychosocial functioning measures: PSP, Clinical Global Impression-Severity (CGI-S), Positive and Negative Syndrome Scale (PANSS), Short-Form 36 (SF-36), treatment satisfaction, sleep quality/daytime drowsiness, and Extrapyramidal Symptoms Rating Scale.

RESULTS

Highest correlations with PSP total score change included PANSS total score change (Spearman's r = 0.607), PANSS general psychopathology change (r = 0.579), and CGI-S change (r = 0.569). A PSP score change of -32 predicted 90% probability of deterioration in CGI-S (score change of ≥1). The power of PSP change to predict PANSS total score change was lower. Linear stepwise regression demonstrated independent relationships for PSP change and: PANSS total change; CGI-S change; SF-36 Mental Component change; treatment satisfaction at endpoint; PSP at baseline; previous psychiatric hospitalizations. R ² = 0.55 meant that 45% of PSP variation could not be explained by other clinical outcome measures.

CONCLUSIONS

Psychosocial functioning improvement is important in schizophrenia. PSP may be valuable for assessing functioning; it encompasses psychosocial and clinical factors not measured by other established assessments.

Would the (too?) normal adaptation to exercise in sickle cell trait carrier be a reflection of preventive mechanisms against potential myocardial and muscle injury?

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission, Region Guadeloupe

Background. Sickle cell trait (SCT) is an inherited red blood cell condition without medical consequence in most cases. However, its strong association with increased risk of exercise-induced sudden death (independent of pre-existing disease) or exertional collapse has been demonstrated in athletes, military recruits and firefighters. The mechanisms potentially leading to cardiac arrest during or after exercise in SCT have not been fully elucidated although contributing factors have been identified (the main one being rhabdomyolysis) or suspected. Warm environment (even without dehydration) can contribute to the occurrence of fatal events.

Purpose. The aims of this study were to 1) compare the biomarkers of myocardial and muscle injury response (and their determinants) to exercise in SCT carriers and controls performing a hard bout of exercise 2) identify the potential deleterious role of warmth during exercise and recovery in SCT and non-SCT.

Methods. Nine otherwise healthy 21 ± 3yo male students with SCT and 11 non-SCT (comparable in physical fitness, regular exercise participation and body mass index) were included. The volunteers performed in a randomized order 3 sessions: cycling exercise in a control (21°C) and warm (31°C) environment followed by recovery in a room at 21°C, and both exercise and recovery in a warm environment. The exercise was as follows: 18-min rectangular moderate intensity period + maximal incremental test + 3 30-s supramaximal sprints spaced with 20-s resting intervals. Recovery and hydration were planned between each exercise part. The ECG was monitored throughout exercise. Blood was sampled before and at the end of the exercise but also during the recovery including a meal up to 130-min after the end of exercise.

Results. No evidence of severe cardiac injury (ECG and biomarkers), rhabdomyolysis or occlusive events (clinical signs and biomarkers), infection (complete blood count), inflammation (biomarkers) or electrolyte imbalance (ionogram) was observed in the SCT carriers of this study: indices were comparable between SCT and non-SCT carriers, with normal exercise-related evolutions and normal recovery. Interestingly, some indices however converge towards a profile with lower complication risk in SCT.

The lactate concentrations tended to be lower in SCT than non-SCT during exercise (p = 0.062) and were significantly lower during the recovery in particular after exercising at 31°C but not at 21°C. The leukocytes count was lower in SCT than non-SCT (p = 0.043) and increased in a greater extent with exercise in the later (p = 0.041). The exercise-induced increase in cortisol and glucose concentrations observed in non-SCT did not occur in SCT carriers (interactions p and p = 0.040 and p = 0.033). Conclusions. Although these results do not evidence pathophysiological mechanisms, they feed the hypothesis of "storm" against which protective mechanisms could have developed and that may fail under particular conditions.

Early schizophrenia patients treated with once-monthly paliperidone palmitate over a 12-month period - a retrospective observational study

Introduction

Little is known about patient characteristics and rehospitalization in newly diagnosed patients with schizophrenia treated with long-acting antipsychotics.

Objectives

To retrospectively explore hospitalizations, drug utilization and clinical outcomes from medical records of young, newly diagnosed schizophrenia patients during the first 12 months of treatment with once-monthly paliperidone palmitate (PP).

Methods

International, multicenter, retrospective, observational study. Outcomes presented are patient characteristics, reason for PP initiation and hospitalization data.

Results

Eighty-four patients were analyzed: mean age (years) at first psychotic episode was 23.8 (SD2.6), 23.9 (SD2.6) at first antipsychotic treatment and 24.1 (SD2.7, range 19-29) at PP initiation. Time between first antipsychotic treatment and PP initiation was 4.8 (SD: 3.4, range: 0-12) months. At PP initiation, 42.9% of patients were in hospital, primarily for the management of the first episode/relapse (97.2%). Reason for PP initiation was: LAT favored over oral treatment for relapse prevention (56%), partial/non adherence with previous oral medication (20.0%), convenience (15.5%) or limited access to health care systems (2.4%). Mean time (days) between admission and initiation of PP, and between initiation of PP and discharge from hospital was 28.8 (SD23.0) and 23.2 (SD24.5), respectively. 96.4% of patients were not hospitalized during the 12-month PP treatment period. 3/84 patients (3.6%) had a single hospitalization of 15.7 (SD: 8.1) days for management of episode/relapse.

Conclusions

In this young, newly diagnosed schizophrenia population, the number of hospitalizations following PP initiation was low. Main reason to initiate PP was clinicians favoring LAT over oral antipsychotic treatment for relapse prevention or due to partial/non adherence with previous oral treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treatment response and tolerability with once-monthly paliperidone palmitate initiated shortly after hospital admission in patients with schizophrenia

OBJECTIVES

Partial or non-adherence in patients with schizophrenia is common and increases the risk of relapse. This study explored safety, tolerability and treatment outcomes in patients hospitalised for an exacerbation of schizophrenia initiated on maintenance treatment of once-monthly paliperidone palmitate (PP1M).

METHODS

A 6-week, observational cohort study of patients initiated on PP1M within 3 weeks after hospital admission.

RESULTS

Overall, 367 patients were documented, 85.8% with paranoid schizophrenia subtype. Mean time from hospital admission to PP1M initiation was 9.4 ± 7.7 days. Treatment-emergent adverse events were reported by 22.9% of patients. From baseline to endpoint, significant improvements were observed in psychotic symptoms (Brief Psychiatric Rating Scale total score mean change -19.3 ± 12.6, P < .0001) and functioning (Personal and Social Performance scale total score mean change 14.3 ± 12.4, P < .0001). Overall, 6.0% of patients were very or extremely satisfied with their prior antipsychotic medication at baseline compared with 47.2% very or extremely satisfied with PP1M treatment at endpoint.

CONCLUSIONS

Initiating PP1M in patients with exacerbated schizophrenia shortly after hospital admission was well tolerated and resulted in statistically significant and clinically relevant improvements in symptoms and patient functioning, suggesting that patients may benefit from early initiation of PP1M during their hospital stay.

Awareness of and satisfaction with available treatment options in schizophrenia: Results from a survey of patients and caregivers in Europe

Introduction

Understanding beliefs and concerns of patients with schizophrenia and their caregivers, regarding treatment options, is key to improving their care. Perceived fears can impact adherence to therapy and represent a barrier to prescribers when discussing treatment decisions.

Objectives

Explore patient and caregiver awareness of and satisfaction with available treatment options.

Methods

Independent market research agency commissioned by Janssen, performed an online European survey in 2016 to capture demographics, awareness of available therapies, current treatment satisfaction and adherence from patients with schizophrenia and caregivers.

Results

Results from 166 patients with schizophrenia and 468 caregivers from 12 European countries (France, Germany, UK, Italy, Spain, Denmark, Russia, Sweden, Austria, Belgium, Switzerland, and the Netherlands). One-fifth of patients reported they have not discussed alternative treatment options with their healthcare professional (HCP) despite 37% of patients being dissatisfied or very dissatisfied with their current therapy. HCPs were considered as the primary information source for the majority of patients (73%), although 27% of patients and 25% of caregivers believed that HCPs were not fully aware of all available treatment options. Moreover, 68% of patients treated with oral antipsychotics confirmed they would consider switching to a long-acting antipsychotic treatment, though 32% reported they have not been made aware of it as an option. Many caregivers (46%) reported dissatisfaction with their level of involvement in treatment decisions.

Conclusions

This survey underlines the critical role HCPs play in providing relevant information on treatment alternatives and emphasize the need for an open dialogue on available treatment options between HCPs, patients and caregivers.

Disclosure of interest

Pierre Cherubin is a full-time Janssen employee working within the Medical Affairs Department.

The other authors have not supplied their declaration of competing interest.

The effect of long-acting paliperidone palmitate once-monthly on negative and depressive symptoms in patients with schizophrenia switched from previous unsuccessful treatment with oral aripiprazole

BACKGROUND

The negative symptoms of schizophrenia are generally harder to recognize, more difficult to treat than positive symptoms, and have a significant impact on patient functioning and overall outcomes. Treatment with aripiprazole may be associated with benefits on negative symptoms and functioning given its partial agonism to the dopamine D₂ receptor. The aim of this subanalysis was to explore the impact of flexibly dosed, long-acting paliperidone palmitate once monthly (PP1M) on negative and depressive symptoms, disorganized thoughts, anxiety, extrapyramidal symptoms, and patient functioning in nonacute adult patients with schizophrenia previously unsuccessfully treated with oral aripiprazole monotherapy.

METHODS

Post-hoc subanalysis of 46 nonacute but symptomatic patients enrolled in a prospective, interventional, single-arm, multicenter, open-label 6-month study.

RESULTS

At endpoint, improvements of ⩾ 20% and ⩾ 50% in the Positive and Negative Syndrome Scale (PANSS) total score were observed in 52.2% and 21.7% of patients, respectively. Significant and clinically relevant improvements were observed at endpoint in mean (standard deviation [SD]) PANSS negative subscale score (-3.0 (5.0); p < 0.0001) and in the PANSS Marder factor scores for negative symptoms (-2.9 (5.4); p = 0.0006), disorganized thoughts (-2.8 (4.3); p < 0.0001) and anxiety/depression (-1.8 (3.9); p = 0.0031). Patient functioning assessed by mean (SD) Personal and Social Performance scale score (3.9 (13.2); p = 0.0409), Mini International Classification of Functioning rating for Activity and Participation Disorders in Psychological Illnesses total scores (-2.9 (7.1); p = 0.0079), and Extrapyramidal Symptom Rating Scale scores (-0.6 (3.4); p = 0.0456) improved significantly at endpoint. PP1M was well tolerated with no new safety signals.

CONCLUSIONS

Six-month treatment with flexibly dosed PP1M was associated with significant and clinically relevant improvements in negative and depressive symptoms, disorganized thoughts, functioning, and extrapyramidal symptoms in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral aripiprazole.

Once-monthly paliperidone palmitate in early stage schizophrenia - a retrospective, non-interventional 1-year study of patients with newly diagnosed schizophrenia

BACKGROUND

Long-acting antipsychotic therapy may be best suited for patients in the early stage of schizophrenia, when the most can be done before disease progression associated with poor adherence occurs. We explored the patterns of use of once-monthly paliperidone palmitate (PP1M), concomitant medication use, hospitalization, and clinical outcomes of adult, newly diagnosed patients with schizophrenia receiving continuous treatment with PP1M for at least 12 months.

METHODS

This was an international, multicenter, exploratory, retrospective chart review of medical records of adult patients who were newly diagnosed (not more than 1 year before initiation of PP1M treatment) with schizophrenia and who had received continuous treatment with PP1M for ≥12 months in naturalistic clinical settings.

RESULTS

A total of 84 (93.3%) patients were included in the analysis. All but one patient (98.8%, n=83) had received oral antipsychotic medication at least during the last month before the first PP1M administration. Three patients (3.6%) were newly hospitalized during the 12-month documentation period. The reason for hospitalization for all three was management of episode/relapse. A total of 79.2% of patients had a ≥20% improvement and 47.2% had a ≥50% improvement in Positive and Negative Syndrome Scale total score from baseline to endpoint. Half of patients (53.3%) showed a significant improvement, as reflected by an increase in Personal and Social Performance (PSP) total score of at least 7 points from baseline to endpoint (mean [SD] 11.9 [15.0] points; P<0.001). One quarter of patients (24.4%, n=11) moved from a PSP score of 31-70 (ie, moderate to marked functional impairment) at baseline to a PSP score of mild to no functional impairment (PSP score ≥71) at endpoint. Most adverse drug reactions were mild or moderate in severity.

CONCLUSION

Continuous treatment with PP1M over 12 months was associated with statistically significant and clinically meaningful improvements in psychotic symptoms, disease severity, and functional outcomes in patients with schizophrenia.

Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia

Objective: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years).

Research design and methods: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients.

Main outcome measures: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann’s test]).

Results: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71–100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings.

Conclusion: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients.

Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia

OBJECTIVE

Relapse and acute exacerbation are common in schizophrenia and may impact treatment response and outcome. Evidence is conflicting in respect to superiority of long-acting injectable antipsychotic therapies versus oral antipsychotics in relapse prevention. This randomized controlled study assessed the efficacy of paliperidone palmitate versus oral antipsychotics for relapse prevention.

METHOD

Eligible patients with a recent diagnosis of schizophrenia (within 1-5 years) were randomized 1:1 to paliperidone palmitate (n=376) or oral antipsychotic monotherapy (n=388) and entered a 2-week initial acute oral treatment phase. Patients who met predefined response criteria were eligible to enter the 24-month rater-blinded core treatment phase. Patients were evaluated for relapse, symptoms, functioning, quality of life, treatment satisfaction, and tolerability.

RESULTS

In the core treatment phase, time to relapse was significantly longer in the paliperidone palmitate (n=352) compared with the oral antipsychotics arm (n=363): 85% of patients were relapse-free at 469 versus 249 days (P=0.019). Significantly fewer patients receiving paliperidone palmitate met the relapse criteria (52 [14.8%] versus 76 [20.9%, oral antipsychotics]; P=0.032), representing a 29.4% relative risk reduction. For paliperidone palmitate, a significantly greater improvement in Positive and Negative Syndrome Scale total score on Day 8 (P=0.021) and a trend at endpoint (P=0.075) were observed. Functioning improvements were comparable between treatment arms. No new safety signals were identified.

CONCLUSION

The observed time to relapse superiority of paliperidone palmitate over oral antipsychotics provides further evidence for the value of long-acting injectable antipsychotic therapies in the treatment of schizophrenia, including during the early stages of illness.

Sécurité d’emploi, tolérance et efficacité du palmitate de palipéridone à doses flexibles chez des patients schizophrènes hospitalisés pour une décompensation psychotique

Objectif

Explorer sécurité d’emploi, tolérance et efficacité du palmitate de palipéridone (PP) à doses flexibles chez des patients adultes schizophrènes hospitalisés pour une décompensation.

Méthodes

Étude internationale, prospective, en ouvert, non-interventionnelle de 6 semaines.

Évaluation

Échelles BPRS (Brief Psychiatric Rating Scale), CGI-S (Clinical Global Impression-Severity), PSP (Personal and Social Performance Scale), questionnaire de satisfaction sur le traitement (MSQ-Medication Satisfaction Questionnaire), ESRS (Extrapyramidal Symptom Rating Scale) et évènements indésirables sous traitement (EIST), entre début d’étude (baseline) et dernière observation rapportée.

Résultats

Trois cent soixante-sept patients analysés (65,9% hommes, âge moyen (± écart-type) 39,8 ± 12,1 ans, 85,8% schizophrénie paranoïde). Au total, 91,6% des patients ont terminé l’étude de 6 semaines. Le délai moyen entre l’admission à l’hôpital et l’initiation du PP était de 9,4 ± 7,7 jours. Le score initial BPRS (50,2 ± 13,6) s’est amélioré de–6,5 ± 8,6 au jour 8 et de–19,3 ± 12,6 à la fin de l’étude (IC 95% = –20,7;–18,0; deux critères avec p < 0,0001). En fin d’étude, 93,6% des patients étaient évalués comme améliorés sur l’échelle CGI-S. Le score de fonctionnement PSP s’est amélioré de 49,4 ± 14,7 à baseline à 14,3 ± 12,4 en fin d’étude (IC 95% = 12,9; 15,8, p < 0,0001). Le score ESRS moyen a diminué de manière significative de 3,7 ± 5,9 (baseline) à 2,0 ± 4,7 en fin d’étude (p < 0,0001). Le pourcentage de patients très ou extrêmement satisfaits par leur traitement antipsychotique est passé de 6,0% à baseline (traitement précédent) à 46,1% en fin d’étude (PP). EIST rapportés chez ≥ 2% des patients: tremblements (2,5%) et schizophrénie (2,2%).

Conclusions

Ces données chez des patients schizophrènes hospitalisés pour décompensation confirment les résultats d’études contrôlées randomisées montrant que le PP à doses flexibles est bien toléré, induit une réponse au traitement rapide et cliniquement significative et une amélioration du fonctionnement. Traduction de l’abstract résumé présenté au congrès EPA 2015 (European Congress of Psychiatry – Vienna, Austria, 28–31 March 2015).

Effets du palmitate de palipéridone sur les symptômes négatifs, la dépression/anxiété, le fonctionnement et les symptômes extrapyramidaux chez des patients souffrant d’une schizophrénie non-aiguë, en échec du traitement par aripiprazole oral

Objectif

Évaluer l’effet du palmitate de palipéridone (PP) à doses flexibles sur les symptômes négatifs, la dépression/anxiété, le fonctionnement et les symptômes extrapyramidaux chez des patients adultes souffrant de schizophrénie non-aiguë, en échec à un traitement par aripiprazole oral.

Méthodes

Étude internationale, prospective, en ouvert de 6 mois.

Évaluations

Variations entre début d’étude (baseline) et dernière observation rapportée sur la PANSS (Positive and Negative Syndrome Scale), la sous-échelle négative de la PANSS, les facteurs de Marder de la PANSS « symptômes négatifs » et « anxiété/dépression », les échelles de fonctionnement PSP (Personal and Social Performance) et Mini-ICF (Mini International Classification of Functioning) et l’échelle ESRS (Extrapyramidal Symptom Rating Scale).

Résultats

Quarante-six patients analysés (73,9 % hommes, âge moyen 34,4 ± 9,4 ans, 78,3 % schizophrénie paranoïde). Parmi les patients, 67,4 % ont terminé l’étude. Avant l’inclusion, la dose moyenne d’aripiprazole oral était de 22,7 ± 10,7 mg/jour. Le score de la sous-échelle négative de PANSS s’est significativement amélioré de 20,3 ± 5,0 (baseline) à 17,3 ± 6,1 (fin d’étude) (variation moyenne = −3,0 ± 5,0 ; IC 95 % = −4,4 ; −1,5 ; p < 0,0001), ainsi que les scores des facteurs de Marder « symptômes négatifs » (de 19,5 ± 5,8 à 16,6 ± 5,9 ; IC95 % = −4,5 ; −1,3, p < 0,0001) et « anxiété/dépression » (de 10,3 ± 3,6 à,5 ± 2,9 ; IC95 % = −3,0 ; −0,6, p = 0,0031). Le score ESRS s’est aussi amélioré de manière significative (de −0,6 ± 3,4 ; IC 95 % = −1,6 ; 0,4, p = 0,0456). Le fonctionnement du patient s’est amélioré de manière significative sur les échelles PSP (de 58,9 ± 13,4 à 62,9 ± 15,2, p = 0,041) et Mini-ICF (de 19,0 ± 7,78 à 16,1 ± 9,84 ; IC 95 % −5,1, −0,7 ; p = 0,0079). Le seul événement indésirable sous traitement rapporté chez ≥ 5 patients a été l’anxiété (n = 6).

Conclusions

La transition d’un échec au traitement par aripiprazole oral à un traitement par PP à doses flexibles chez des patients souffrant de schizophrénie non-aiguë a été bien tolérée et s’est traduit par une amélioration significative des symptômes négatifs, dépressifs, anxieux et des symptômes extrapyramidaux, ainsi que du fonctionnement du patient.

Traduction de l’abstract résumé présenté au congrès EPA 2015 (European Congress of Psychiatry, Vienna, Austria, 28–31 March 2015)

Paliperidone palmitate in non-acute patients with schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot antipsychotics

PALMFlexS, a prospective multicentre, open-label, 6-month, phase IIIb interventional study, explored tolerability, safety and treatment response in adults (n = 231) with non-acute but symptomatic schizophrenia switching to flexibly dosed paliperidone palmitate (PP) after unsuccessful treatment with risperidone long-acting injectable therapy (RLAT) or conventional depot antipsychotics (APs). Treatment response was measured by change in Positive and Negative Syndrome Scale (PANSS) total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events. Significant reductions in mean PANSS total score were observed for all groups (-7.5 to -10.6; p ⩽ 0.01 [BL to LOCF EP]). After switching to PP, more than 50% of all patients achieved ⩾20% and one-third of RLAT-treated patients even achieved ⩾50% improvement in PANSS total score. Across groups, there were significant improvements (p < 0.05) in symptom severity as measured by Clinical Global Impression-Severity (CGI-S; trend for improvement with RLAT; p = 0.0568), subjective well-being, medication satisfaction, and patient functioning with PP. PP was generally well tolerated. Clinically relevant benefits were observed in non-acute patients with schizophrenia switched from RLAT or conventional depot APs to PP.

Intramuscular long-acting paliperidone palmitate in acute patients with schizophrenia unsuccessfully treated with oral antipsychotics

In this prospective multicentre, open-label, 6-month study (Paliperidone Palmitate Flexible Dosing in Schizophrenia [PALMFlexS]), tolerability, safety and treatment response with paliperidone palmitate (PP) were explored in patients with acute symptoms of schizophrenia following switching from previously unsuccessful treatment with oral antipsychotics. This pragmatic study was conducted in a large, more representative sample of the general schizophrenia population compared to randomized controlled pivotal trials, to specifically mimic real-world clinical situations. After initiation on Day 1 and Day 8, patients received PP once monthly at flexible doses (50-150mgeq.) intramuscularly. The primary efficacy outcome was defined as the percentage of patients achieving ≥30% improvement in PANSS total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events (TEAEs). Overall, 212 patients received PP at least once after switching from oral antipsychotics, primarily due to lack of efficacy (45.8%). Significant improvements from BL in mean (SD) PANSS total score were observed from Day 8 onwards (BL to LOCF EP: -31.0 [29.0]; p<0.0001). At endpoint, two-thirds (66.7%) and 43.5% of patients achieved a ≥30% and ≥50% improvement in mean PANSS total score, respectively. PP was associated with significant improvements across secondary measures of symptom severity, subjective well-being, medication satisfaction, illness-related disorders of activity and participation, and patient functioning (p<0.0001; BL to LOCF EP). PP was generally well tolerated, with significant reductions in ESRS total score (p<0.0001) and mainly mild-to-moderate TEAEs. TEAEs reported in ≥5% of patients were injection-site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache and anxiety (both 6.1%). The PALMFlexS study findings provide valuable pragmatic clinical data on PP treatment in patients with acute schizophrenia previously unsuccessfully treated with oral antipsychotics.

Long-acting injectable risperidone and oral antipsychotics in patients with schizophrenia: results from a prospective, 1-year, non-interventional study (InORS)

OBJECTIVE

To explore differences in outcomes for patients with schizophrenia treated with risperidone long-acting treatment (RLAT) or oral antipsychotics (oAP).

METHODS

The International Observational Registry on Schizophrenia (InORS) explored flexible doses of newly initiated RLAT and oAPs for adults with schizophrenia, exploring 6-month retrospective hospitalization data and 12-month prospective medication use, outcomes, and tolerability. Efficacy outcomes included hospitalizations, the Clinical Global Impression of Schizophrenia (CGI-SCH), and the Global Assessment of Functioning (GAF). Medication switch patterns were also analysed.

RESULTS

Data were analysed from 1083 patients (561 RLAT, 522 oAP). At baseline, RLAT patients had higher symptom severity, greater functional impairment, and poorer compliance. Percentages of patients hospitalized were similar between groups, and median duration per hospitalization decreased after RLAT initiation and with oAP. The difference in duration of hospitalization between the retrospective and prospective period was significantly better with RLAT (P = 0.002). Mean CGI-SCH change from baseline was significantly better for RLAT vs. oAP patients for overall, positive, and negative symptom scores (P < 0.05). Mean functional improvement from baseline was significantly higher with RLAT vs. oAP (P < 0.001).

CONCLUSIONS

Hospitalizations and symptomatic and functional outcomes were better with RLAT vs. oAP; frequent medication switches were associated with less favourable outcomes.

Amélioration fonctionnelle sous palmitate de paliperidone à doses flexibles chez des patients aigus ou non aigus atteints de schizophrénie, après échec d’un traitement par antipsychotiques oraux

Objectifs

Évaluer l’amélioration fonctionnelle chez des patients atteints de schizophrénie sous palmitate de paliperidone (PP) à doses flexibles après échec d’un traitement par antipsychotiques oraux.

Méthodes

Analyse menée dans deux sous-groupes de patients atteints de schizophrénie : aigus (n = 202) et non aigus (n = 593) après échec d’un traitement par antipsychotiques oraux, inclus dans une étude internationale, prospective, de six mois.

Critères d’évaluation

Changement du score total à la PANSS (Positive and Negative Syndrome Scale), à la PSP (Personal and Psychosocial Performance scale), et à la Mini-ICF-APP (Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses).

Résultats

Les deux sous-groupes ont présenté une amélioration significative du score total à la PANSS : de 98,5 ± 20,1 à l’inclusion à 67,4 ± 24,0 à la fin de l’étude (diminution moyenne = −31,0 ± 29,0) chez les patients aigus et de 71,5 ± 14,6 à 59,7 ± 18,1 (diminution moyenne = −11,7 ± 15,9) chez les patients non aigus. Cette réponse thérapeutique était associée à une augmentation significative du score total à la PSP de 43,9 ± 15,0 à 62,9 ± 17,1 (amélioration moyenne = 19,0 ± 18,7, p <0,0001) chez les patients aigus, et de 58,1 ± 13,4 à 66,1 ± 15,7 (amélioration moyenne =8,0 ± 14,0, p < 0,0001) chez les patients non aigus. Il existait une amélioration significative du score à la Mini-ICF-APP qui diminuait de 26,8 ± 8,5 à 18,5 ± 9,8 (diminution moyenne = −8,0 ± 10,4, p < 0,0001) chez les patients aigus et de 19,8 ± 7,9 à 15,9 ± 8,8 (diminution moyenne = −4,0 ± 7,5, p < 0,0001) chez les patients non aigus.

Conclusions

L’amélioration symptomatique sous PP à doses flexibles chez des patients aigus ou non-aigus atteints de schizophrénie après échec d’un traitement par antipsychotique oral s’est accompagnée d’une amélioration fonctionnelle cliniquement significative.

Palmitate de palipéridone à doses flexibles – Réponse thérapeutique, tolérance et sécurité d’emploi: une étude prospective chez des patients en période d’exacerbation aiguë d’un trouble schizophrénique après échec d’un traitement par antipsychotiques oraux

Objectifs

Évaluer la tolérance, la sécurité d’emploi et l’efficacité de doses flexibles de PP chez des patients adultes en période d’exacerbation aiguë d’une schizophrénie, après échec d’un traitement par antipsychotiques oraux.

Méthodes

Étude internationale, prospective, ouverte, de six mois.

Critères d’évaluation

Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), événements indésirables (EI), changement de poids.

Résultats

Deux cent douze patients (population en intention de traiter) : âge moyen 36,4 ± 12,1 ans, 59,0 % d’hommes, 85,4 % souffrant de schizophrénie paranoïde ont été inclus. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (45,8 %). 70,3 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce ont été : le choix du patient (9,4 %), des EI (9,0 %), les perdus de vue (4,7 %), le manque d’efficacité (2,8 %). Le score total moyen à la PANSS initiale (98,5 ± 20,1) a diminué, et ce dès j8, pour atteindre 67,4 ± 24,0 à la fin de l’étude (diminution de −31,0 ± 29,0, p < 0,0001). 66,7 % des patients ont eu une amélioration de plus de 30 % du score PANSS total et le pourcentage de patients jugés manifestement malades ou pire (CGI-S) a diminué de 75,1 % à 20,5 %. Les EIs (≥ 5 % patients) : douleur au site d’injection (13,7 %), insomnie (10,8 %), trouble psychotique (10,4 %), céphalées (6,1 %) et anxiété (6,1 %). Le changement moyen de poids a été de 2,6 ± 5,6 kg (IC 95 % [1,8; 3,4]).

Conclusions

Ces résultats confirment que le PP à doses flexibles est bien toléré et permet une réponse clinique précoce et cliniquement significative chez des patients en période d’exacerbation aiguë de leur trouble schizophrénique, après échec d’un traitement par antipsychotiques oraux.