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Wang D, Schneider-Thoma J, Siafis S, Qin M, Wu H, Zhu Y, Davis JM, Priller J, Leucht S. Efficacy, acceptability and side-effects of oral versus long-acting- injectables antipsychotics: Systematic review and network meta-analysis. Eur Neuropsychopharmacol 2024; 83:11-18. [PMID: 38490016 DOI: 10.1016/j.euroneuro.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Long-acting injectable antipsychotics (LAIs) are primarily used for relapse prevention, but in some settings and situations, they may also be useful for acute treatment of schizophrenia. We conducted a systematic review and frequentist network meta-analysis of randomized-controlled trials (RCTs), focusing on adult patients in the acute phase of schizophrenia. Interventions were risperidone, paliperidone, aripiprazole, olanzapine, and placebo, administered either orally or as LAI. We synthesized data on overall symptoms, complemented by 17 other efficacy and tolerability outcomes. Confidence in the evidence was assessed with the Confidence-in-Network-Meta-Analysis-framework (CINeMA). We included 115 RCTs with 25,550 participants. All drugs were significantly more efficacious than placebo with the following standardized mean differences and their 95 % confidence intervals: olanzapine LAI -0.66 [-1.00; -0.33], risperidone LAI -0.59[-0.73;-0.46], olanzapine oral -0.55[-0.62;-0.48], aripiprazole LAI -0.54[-0.71; -0.37], risperidone oral -0.48[-0.55;-0.41], paliperidone oral -0.47[-0.58;-0.37], paliperidone LAI -0.45[-0.57;-0.33], aripiprazole oral -0.40[-0.50; -0.31]. There were no significant efficacy differences between LAIs and oral formulations. Sensitivity analyses of the primary outcome overall symptoms largely confirmed these findings. Moreover, some side effects were less frequent under LAIs than under their oral counterparts. Confidence in the evidence was moderate for most comparisons. LAIs are efficacious for acute schizophrenia and may have some benefits compared to oral formulations in terms of side effects. These findings assist clinicians with insights to weigh the risks and benefits between oral and injectable agents when treating patients in the acute phase.
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Affiliation(s)
- Dongfang Wang
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; German Center for Mental Health (DZPG), partner site München/Augsburg, Munich, Germany
| | - Mengchang Qin
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Hui Wu
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Yikang Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA and Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Josef Priller
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; German Center for Mental Health (DZPG), partner site München/Augsburg, Munich, Germany; Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; German Center for Mental Health (DZPG), partner site München/Augsburg, Munich, Germany.
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Bartoli F, Callovini T, Cavaleri D, Crocamo C, Riboldi I, Aguglia A, De Fazio P, Martinotti G, D'Agostino A, Ostuzzi G, Barbui C, Carrà G. Effect of long-acting injectable antipsychotics on 1-year hospitalization in bipolar disorder: a mirror-image study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1579-1586. [PMID: 36436121 DOI: 10.1007/s00406-022-01522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
Long-acting injectable (LAI) antipsychotics are often used for the long-term management also of bipolar disorder (BD). Nonetheless, evidence on their effect on pragmatic outcomes such as hospitalization risk in BD is inconsistent. We carried out a mirror-image study comparing rates and number of days of hospitalization, one year before and after the initiation of LAI treatment, in a sample of subjects with BD. Participants were selected from the STAR Network Depot Study, a pragmatic, observational, multicenter research involving a cohort of inpatients and outpatients consecutively started on LAI treatment. Variations in rates and in total number of days of hospitalization between the 12 months before and those after treatment initiation were analyzed. Among 461 individuals screened for eligibility, we included 71 adults with BD, initiated either on first- (FGA) or second-generation (SGA) LAIs. We found a significant decrease in terms of 12-month hospitalization rates (p < 0.001) and number of days (p < 0.001) after LAI initiation, without any effect by age, gender, alcohol/substance use disorders, and symptom severity. Subgroup analyses based on antipsychotic class, history of LAI treatment, and concomitant oral medications, confirmed the decreasing trend on both hospitalization rates and number of days. However, these reductions were not significant among participants who continued this treatment for less than 6 months. Comprehensively, this study supports the role of LAIs as effective maintenance treatment options for BD. Further research is needed to identify clinical characteristics of people with BD who would most benefit from long-acting formulations of antipsychotics.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti, Pescara, Chieti, Italy
| | | | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Kasahara-Kiritani M, Saga Y, Wakamatsu A, Wu DBC, Tsai IC. Clinical benefit of second-generation long-acting injectable antipsychotics in preventing re-hospitalization in patients with schizophrenia: A real-world study in Japan. Asian J Psychiatr 2023; 86:103671. [PMID: 37311333 DOI: 10.1016/j.ajp.2023.103671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Real-world evidence on the benefits of long-acting injectable (LAI) antipsychotics (AP) in patients with schizophrenia is limited, especially in the employed population in Japan. This study evaluates the effectiveness of LAI AP in preventing re-hospitalization in patients with schizophrenia, including the employed population. METHODS This retrospective, observational, population-based study used the Japan Medical Data Center (JMDC) health insurance claims database to identify patients having schizophrenia before or on the day of the first LAI AP prescription (index date), and receiving LAI AP between April 1, 2012 and December 31, 2019. The number of all-cause, psychiatric-, and schizophrenia-related hospitalizations at baseline (365 days before index date) and during the 1-year follow-up period were evaluated. RESULTS Of the 1692 patients who received LAI AP during the study period, 146 were included (employed: 55 [37.7 %]; dependent: 91 [62.3 %]). The mean age was 37 years; 50.7 % (n = 74) were females. During baseline period, 61 (41.8 %) patients were not hospitalized. During the follow-up period, 67 (45.9 %) patients underwent hospitalization ≤ 7 days; all-cause: 100 (68.7 %); psychiatry-related: 104 (76.2 %); schizophrenia-related: 114 (78.1 %). A higher proportion of patients were hospitalization-free during the follow-up in the employed vs. dependent population: all cause: 69.1 % vs. 61.5 %; psychiatric-related 76.4 % vs. 67.0 %, schizophrenia-related: 87.3 % vs. 71.4 %. CONCLUSION This study demonstrated the effectiveness of LAI AP in preventing hospitalization in Japan. During the follow-up period, patients with schizophrenia receiving LAI AP, including the employed population, had a significant decrease in hospitalization length and re-hospitalization rate compared to baseline.
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Affiliation(s)
- Mami Kasahara-Kiritani
- Integrated Market Access Division, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan.
| | - Yosuke Saga
- Medical Affairs, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
| | - Akihide Wakamatsu
- Medical Affairs, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
| | - David Bin-Chia Wu
- Regional Market Access & Government Affairs (Asia Pacific), Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; School of Pharmacy, Monash University Malaysia, Malaysia
| | - I-Ching Tsai
- Integrated Market Access Division, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
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Okada Y, Inada K, Akazawa M. Comparative effectiveness of long-acting injectable antipsychotics in patients with schizophrenia in Japan. Schizophr Res 2023; 252:300-308. [PMID: 36706475 DOI: 10.1016/j.schres.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/31/2022] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the effectiveness of different long-acting injectable antipsychotics (LAIs) (aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol) in patients with schizophrenia in Japan. METHODS We conducted a retrospective cohort study using two administrative claims databases. The study population consisted of outpatients with schizophrenia who initiated LAIs between May 1, 2015, and November 30, 2019. We directly compared the risk of psychiatric hospitalization and LAI discontinuation among the LAIs based on hazard ratios (HRs) using Cox proportional hazards regression models. RESULTS The numbers of eligible patients who initiated aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol were 303, 124, 73, and 123, respectively. Regarding psychiatric hospitalization, aripiprazole and paliperidone were associated with significantly lower risk compared to fluphenazine/haloperidol (HR of aripiprazole: 0.47, 95 % CI: 0.28-0.78, HR of paliperidone: 0.50, 95 % CI: 0.28-0.89); HR of risperidone showed the same trend as the aripiprazole and paliperidone. Regarding LAI discontinuation, aripiprazole and paliperidone were associated with significantly lower risk of LAI discontinuation compared to fluphenazine/haloperidol (HR of aripiprazole: 0.53, 95 % CI: 95 % CI: 0.35-0.80, HR of paliperidone: 0.57, 95 % CI: 0.35-0.92). Aripiprazole was also associated with a significantly lower risk compared to risperidone (HR: 0.56, 95 % CI: 0.32-0.98). CONCLUSION Our study suggests that aripiprazole and paliperidone are superior to fluphenazine/haloperidol in the risk of psychiatric hospitalization and LAI discontinuation. Aripiprazole is superior to risperidone in the risk of LAI discontinuation.
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Affiliation(s)
- Yusuke Okada
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
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Barlati S, Nibbio G, Bianchi F, Gigli EBL, Calzavara-Pinton I, Cerati C, Fiori J, Lisoni J, Deste G, Vita A. Long-acting Injectable Antipsychotics during the COVID-19 pandemic in schizophrenia: An observational study in a real-world clinical setting. Psychiatry Res 2022; 317:114878. [PMID: 36206591 DOI: 10.1016/j.psychres.2022.114878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
The COVID-19 pandemic is having an important impact on the practice of mental health services and on schizophrenia patients, and heterogeneous and conflicting findings are being reported on the reduction of long-acting injectable (LAI) antipsychotics use. Aims of the study were to assess the total number of patients treated with LAI, the start of novel LAI and the discontinuation of LAI treatments, analyzing register data of the first year of the pandemic, 2020, compared to a pre-pandemic reference year, 2019. Data from two outpatient centers were retrieved, for a total of 236 participants in 2020: no significant differences were observed comparing 2020 and 2019 when considering the total number of patients on LAI treatment (p = 0.890) and the number of dropouts (p = 0.262); however, a significant reduction in the start of LAI was observed (p = 0.022). In 2020, second generation LAI were more prescribed than first generation LAI (p = 0.040) while no difference was observed in 2019 (p = 0.191). These findings attest the efficacy of measures adopted in mental health services to face the consequences of COVID-19 and shed further light on the impact of the pandemic on the clinical practice of mental health services and on the continuity of care of people with schizophrenia.
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D’Agostino A, Aguglia A, Barbui C, Bartoli F, Carrà G, Cavallotti S, Chirico M, Ostinelli EG, Zangani C, Martinotti G, Ostuzzi G. Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study. BMC Psychiatry 2022; 22:442. [PMID: 35773631 PMCID: PMC9245273 DOI: 10.1186/s12888-022-04071-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. METHOD In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. RESULTS SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. CONCLUSION Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns.
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Affiliation(s)
- Armando D’Agostino
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università degli Studi di Milano, Milan, Italy ,grid.415093.a0000 0004 1793 3800Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Andrea Aguglia
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Corrado Barbui
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Francesco Bartoli
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Carrà
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Simone Cavallotti
- grid.415093.a0000 0004 1793 3800Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Margherita Chirico
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università degli Studi di Milano, Milan, Italy ,grid.415093.a0000 0004 1793 3800Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Edoardo G. Ostinelli
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università degli Studi di Milano, Milan, Italy ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.8241.f0000 0004 0397 2876Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Caroline Zangani
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università degli Studi di Milano, Milan, Italy ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.8241.f0000 0004 0397 2876Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Giovanni Martinotti
- grid.412451.70000 0001 2181 4941Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy
| | - Giovanni Ostuzzi
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Joo SW, Kim H, Jo YT, Ahn S, Choi YJ, Choi W, Park S, Lee J. Comparative effectiveness of antipsychotic monotherapy and polypharmacy in schizophrenia patients with clozapine treatment: A nationwide, health insurance data-based study. Eur Neuropsychopharmacol 2022; 59:36-44. [PMID: 35550204 DOI: 10.1016/j.euroneuro.2022.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/31/2022]
Abstract
Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia (TRS). However, it remains uncertain whether antipsychotic augmentation to clozapine has the superior effectiveness over clozapine alone and the effect size of clozapine compared to other antipsychotic drugs in TRS. Therefore, we examined the comparative effectiveness of antipsychotic monotherapy and polypharmacy on the risk of psychiatric admission and treatment discontinuation in TRS. Data were collected from the Health Insurance Review Agency database between January 2010 and December 2019 in South Korea. Among prevalent patients with schizophrenia, we defined 22,327 patients with TRS as those who had been prescribed with clozapine at least once during the entire observation period. Stratified Cox proportional hazards regressions were performed using data on all antipsychotic prescriptions of patients with TRS to investigate the risk of psychiatric hospitalization and treatment discontinuation associated with antipsychotic treatment. In individual comparisons, clozapine monotherapy was the most effective for the risk of psychiatric hospitalization compared to no use (hazard ratio [HR] = 0.23, 95% confidence interval [CI] = 0.22-0.25). In group comparisons, clozapine with long-acting injectable (LAI) second-generation antipsychotics (SGA) was superior to clozapine monotherapy for the risk of psychiatric hospitalization (HR = 0.60, 95%CI = 0.41-0.88). Clozapine monotherapy was associated with the lowest risk of treatment discontinuation in the individual and group comparisons. This retrospective observational population-based study reports that clozapine with LAI SGA is more effective in lowering the risk of psychiatric hospitalization in antipsychotic group comparison with the reference of clozapine monotherapy.
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Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Young Tak Jo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Soojin Ahn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Young Jae Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Woohyeok Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea
| | - Soyeon Park
- Department of Psychiatry, Medical Foundation Yongin Mental Hospital, Yongin, Republic of Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, SongPa-Gu, Seoul 05505, Republic of Korea.
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Pippal N, Halder S, Srivastava S, Kar R, Gupta R, Anthonio AE. Correlation between telomere length and efficacy of oral and long-acting injectable antipsychotics on severity and cognitive impairment of schizophrenia. Int J Psychiatry Clin Pract 2022; 26:157-164. [PMID: 34715000 DOI: 10.1080/13651501.2021.1994613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the correlation between telomere length (TL) and long-acting injectable (LAI) and oral atypical antipsychotic (OAA) efficacy on schizophrenia (SCZ) severity and cognitive impairment. METHODS Sixty Schizophrenia patients of 18-50 years and of either sex were included in a 12-week study. Thirty patients were recruited in each group, LAI and OAA. Positive and Negative Syndrome Scale (PANSS) and National Institute of Mental Health and Neuro-Sciences (NIMHANS) neuropsychological battery tests were evaluated at baseline and 12 weeks. TL was estimated at baseline. RESULTS Both groups showed a significant improvement in PANSS and NIMHANS battery test scores after treatment (p < 0.001) within the group, though not between the groups. Mean TL at baseline was 407.58 ± 143.93 and 443.40 ± 178.46 in LAI and OAA groups respectively. A significant negative correlation (r = -0.28, p = 0.03) of TL was seen with the mean change in negative PANSS score after treatment. CONCLUSIONS LAI antipsychotics are similar to OAA in decreasing the disorder severity and improving the cognitive impairment in schizophrenia. Also, patients who have shorter TL show greater improvement in the negative PANSS score. Hence, TL holds the potential of predicting antipsychotic drug response in schizophrenia patients.KEY POINTSLong-acting injectable antipsychotic was comparable to oral atypical antipsychotics in bringing out improvement in disorder severity, cognitive functions over 12 weeks.Shorter telomere length has been found to be associated with a greater response in negative symptoms of schizophrenia.
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Affiliation(s)
- Nisha Pippal
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sumita Halder
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shruti Srivastava
- Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rajarshi Kar
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Almeida Edelbert Anthonio
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Alphs L, Brown B, Turkoz I, Baker P, Fu DJ, Nuechterlein KH. The Disease Recovery Evaluation and Modification (DREaM) study: Effectiveness of paliperidone palmitate versus oral antipsychotics in patients with recent-onset schizophrenia or schizophreniform disorder. Schizophr Res 2022; 243:86-97. [PMID: 35247794 DOI: 10.1016/j.schres.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
We report primary results of the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial designed to compare the effectiveness of paliperidone palmitate (PP) versus oral antipsychotics (OAP) in delaying time to first treatment failure (TtFTF) in participants with recent-onset schizophrenia or schizophreniform disorder. DREaM included: Part I, 2-month oral run-in; Part II, 9-month disease progression phase (PP or OAP); Part III, 9 months of additional treatment (PP/PP; OAP rerandomized: OAP/OAP or OAP/PP). PP/PP and OAP/OAP comprised the 18-month extended disease progression (EDP) analysis. A total of 235 participants were randomized to PP (n = 78) or OAP (n = 157) in Part II. No statistically significant differences in TF between treatment groups were identified during Part II (PP 29.5%, OAP 24.8%; P = 0.377), Part III (PP/PP 14.3%, OAP/PP 15.8%, OAP/OAP 28.6%; P = 0.067) or the EDP analysis (PP/PP 28.6%, OAP/OAP 44.4%; NNT = 6; P = 0.080). Using a modified definition of TF excluding treatment supplementation with another antipsychotic, a common approach to managing dose adjustments, significant differences were observed between treatment groups in Part III (PP/PP 4.1%, OAP/PP 14.0%, OAP/OAP 27.0%; P = 0.002) and EDP (PP/PP 14.3%, OAP/OAP 42.9%; P = 0.001). Safety results were consistent with the known safety profile of PP. Although significant treatment differences were not observed during the first 9 months of DREaM, numerical differences favoring PP emerged in the last 9 months and significant differences were observed when TF criteria were limited to their most impactful components. These results highlight the potential benefit of initiating PP early in the course of schizophrenia and provide valuable insights for future clinical trials in recent-onset schizophrenia or schizophreniform disorder. Clinicaltrials.gov identifier: NCT02431702.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Brianne Brown
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Pamela Baker
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Dong-Jing Fu
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California at Los Angeles, 150 Medical Plaza Driveway, Los Angeles, CA 90095, USA.
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10
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Bartoli F, Cavaleri D, Callovini T, Riboldi I, Crocamo C, D'Agostino A, Martinotti G, Bertolini F, Ostuzzi G, Barbui C, Carrà G; STAR Network Depot Investigators. Comparing 1-year effectiveness and acceptability of once-monthly paliperidone palmitate and aripiprazole monohydrate for schizophrenia spectrum disorders: Findings from the STAR Network Depot Study. Psychiatry Res 2022; 309:114405. [PMID: 35093701 DOI: 10.1016/j.psychres.2022.114405] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 11/24/2022]
Abstract
In this prospective study, we assessed the effectiveness and acceptability of paliperidone palmitate 1-month (PP1M) and aripiprazole monohydrate (AM) over 1-year follow-up. We included 195 subjects (117 treated with PP1M and 78 with AM) with schizophrenia spectrum disorders from real-world settings. We estimated no differences in hospitalization (Odds Ratio=1.59; p = 0.12), symptoms improvement (p = 0.90 adjusted for baseline severity), and discontinuation (Hazard Ratio=0.72; p = 0.20) at study endpoint. Although current evidence suggests the possible superiority of AM over PP1M, our findings showed comparable effectiveness between these drugs. Additional studies in real-world settings with direct comparisons between these two LAIs are needed.
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11
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Correll CU, Chepke C, Gionfriddo P, Parks J, Foxworth P, Basu A, Brister TS, Brown D, Clarke C, Hassoun Y. The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach. BMC Psychiatry 2022; 22:32. [PMID: 35012512 PMCID: PMC8745550 DOI: 10.1186/s12888-022-03685-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. METHODS Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. RESULTS Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. CONCLUSIONS The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
| | | | - Joe Parks
- National Council for Behavioral Health, Washington, DC, USA
| | | | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Departments of Pharmacy, Health Services, and Economics, University of Washington, Seattle, WA, USA
| | | | - Dawn Brown
- National Alliance on Mental Illness, Arlington, VA, USA
| | - Christopher Clarke
- Enterprise Digital Health, University of Southern California, Los Angeles, CA, USA
| | - Youssef Hassoun
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
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Xiao L, Zhao Q, Li AN, Sun J, Wu B, Wang L, Zhang H, Zhang R, Li K, Xu X, Liu T, Zhang W, Xie S, Xu X, Tan Y, Zhang K, Zhang H, Guan N, Xian M, Uki M, Wang G. Efficacy and safety of aripiprazole once-monthly versus oral aripiprazole in Chinese patients with acute schizophrenia: a multicenter, randomized, double-blind, non-inferiority study. Psychopharmacology (Berl) 2022; 239:243-51. [PMID: 34989824 DOI: 10.1007/s00213-021-06044-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study aimed to evaluate the efficacy and safety of aripiprazole once-monthly (AOM) compared to oral aripiprazole in treating acute schizophrenia. METHODS This randomized, double-blind, non-inferiority study recruited patients from 15 trial sites across China from May 2017 to April 2019. Patients with an acute psychotic episode received AOM at 400 mg or oral aripiprazole at 10-20 mg for 12 weeks. The primary and secondary efficacy endpoints were the difference in scores from baseline to week 10, as assessed on the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S) scores, respectively. RESULTS A total of 436 patients were randomized. Among them, 159/218 (72.9%) and 165/218 (75.7%) in the AOM and oral aripiprazole groups completed 10 weeks of treatment, respectively. The least-squares (LS) mean changes from baseline to endpoint (week 10) in PANSS were - 33.6 for the AOM group and - 34.8 in the oral aripiprazole group, respectively, with a difference of - 1.2 (95% CI: - 4.1, 1.7). The non-inferiority margin of AOM to oral aripiprazole was - 4.1, which was above the lower limit of the pre-defined margin. The altered CGI-S score was - 2.2 and - 2.3 in the AOM and oral aripiprazole groups, respectively. The incidence of treatment-emergent adverse events (TEAEs) was similar in both groups. The rate of discontinuation due to TEAEs was 2.3% and 3.2% in the AOM and oral aripiprazole groups, respectively. CONCLUSIONS This study confirmed the efficacy and safety of AOM for the treatment of Chinese patients with acute schizophrenia. The non-inferiority of AOM to oral aripiprazole was established, with comparable efficacy and tolerability. These findings suggested that AOM could be used as a treatment option for patients experiencing an acute episode of schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03172871.
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McKee KA, Crocker CE, Tibbo PG. Long-acting injectable antipsychotic (LAI) prescribing trends during COVID-19 restrictions in Canada: a retrospective observational study. BMC Psychiatry 2021; 21:633. [PMID: 34930204 PMCID: PMC8687150 DOI: 10.1186/s12888-021-03646-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had significant impacts on how mental health services are delivered to patients throughout Canada. The reduction of in-person healthcare services have created unique challenges for individuals with psychotic disorders that require regular clinic visits to administer and monitor long-acting injectable antipsychotic medications. METHODS To better understand how LAI usage was impacted, national and provincial patient-level longitudinal prescribing data from Canadian retail pharmacies were used to examine LAI prescribing practices during the pandemic. Prescribing data on new starts of medication, discontinuations of medications, switches between medications, antipsychotic name, concomitant medications, payer plan, gender and age were collected from January 2019 to December 2020 for individuals ≥18-years of age, and examined by month, as well as by distinct pandemic related epochs characterized by varying degrees of public awareness, incidence of COVID-19 infections and public health restrictions. RESULTS National, and provincial level data revealed that rates of LAI prescribing including new starts, discontinuations and switches between LAI products remained highly stable (i.e., no statistically significant differences) throughout the study period. CONCLUSIONS Equal numbers of LAI new starts and discontinuations prior to and during the pandemic suggests prescribing of LAI antipsychotics, for those already in care, continued unchanged throughout the pandemic. The observed consistency of LAI prescribing contrasts with other areas of healthcare, such as cardiovascular and diabetes care, which experienced decreases in medication prescribing during the COVID-19 pandemic.
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Affiliation(s)
- Kyle A. McKee
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, Halifax, Nova Scotia B3H 2E2 Canada
| | - Candice E. Crocker
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, Halifax, Nova Scotia B3H 2E2 Canada ,grid.55602.340000 0004 1936 8200Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia Canada
| | - Philip G. Tibbo
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, Halifax, Nova Scotia B3H 2E2 Canada
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Chan HW, Huang CY, Yen YC. Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study. BMC Psychiatry 2021; 21:507. [PMID: 34654391 PMCID: PMC8518212 DOI: 10.1186/s12888-021-03513-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Schizophrenia is a severe psychiatric disorder. Poor medical adherence increases relapse rate. Long-acting injection of antipsychotic agent is developed for improving medical adherence. In this study, we examined the effect of paliperidone long-acting injection (PLAI) treatment in patients with schizophrenia in a real-world setting. METHODS In this retrospective cohort study, 467 patients with schizophrenia were enrolled, treated with risperidone PLAI or oral antipsychotics, and followed for 1 year. Concomitant medication, namely anticonvulsants, antidepressants, anxiolytics, sedatives or hypnotics, anticholinergics, and beta-blockers, were administered. Patients were classified into 2 groups: the LAI group (patients received LAI for treatment) and the NLAI group (patients taking only oral antipsychotics). The incidence of hospitalization, the length of hospitalization, and the incidence of emergency room visits were assessed. RESULTS The LAI group had a higher incidence of psychiatric acute ward admission (NLAI group = 4.8%; LAI = 30.3%) and emergency room visits (NLAI group = 7.3%; LAI group = 36.0%) before enrolment. During the one-year follow-up, the incidence of acute ward admission and emergency room visit did not differ in the NLAI group (P = .586 and .241) compared with before enrolment, whereas both incidences were significantly decreased in the LAI group (P < .0001 in both of them). CONCLUSIONS PLAI reduces the incidence of admission and emergency room visits.
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Affiliation(s)
- Hsue-Wei Chan
- grid.414686.90000 0004 1797 2180Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824 Taiwan
| | - Chin-Yu Huang
- grid.414686.90000 0004 1797 2180Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824 Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan. .,School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Suetani S, Siskind D, Phillipou A, Waterreus A, Morgan VA, Castle D. Characteristics of people on long-acting injectable antipsychotics in Australia: Data from the 2010 National Survey of High Impact Psychosis. Aust N Z J Psychiatry 2021; 55:958-975. [PMID: 33906481 DOI: 10.1177/00048674211009602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigates (1) the proportion of people with psychosis who are on long-acting injectable antipsychotics; (2) the difference in the demographic, clinical, substance use and adverse drug reaction profiles of people taking long-acting injectables compared to oral antipsychotics; and (3) the differences in the same profiles of those on first-generation antipsychotic versus second-generation antipsychotic long-acting injectables. METHODS Data were collected as part of the Survey of High Impact Psychosis. For this study, participants with diagnoses of schizophrenia or schizoaffective disorder who were on any antipsychotic medication were included (N = 1049). RESULTS Nearly a third (31.5%) of people with psychosis were on long-acting injectables, of whom 49.7% were on first-generation antipsychotic long-acting injectables and 47.9% were on second-generation antipsychotic long-acting injectables. This contrasts with oral antipsychotics where there was a higher utilisation of second-generation antipsychotics (86.3%). Of note, compared to those on the oral formulation, people on long-acting injectables were almost four times more likely to be under a community treatment order. Furthermore, people on long-acting injectables were more likely to have a longer duration of illness, reduced degree of insight, increased cognitive impairment as well as poor personal and social functioning. They also reported more adverse drug reactions. Compared to those on first-generation antipsychotic long-acting injectables, people on SGA long-acting injectables were younger and had had a shorter duration of illness. They were also more likely to experience dizziness and increased weight, but less likely to experience muscle stiffness or tenseness. CONCLUSION Long-acting injectable use in Australia is associated with higher rates of community treatment order use, as well as poorer insight, personal and social performance, and greater cognitive impairment. While long-acting injectables may have the potential to improve the prognosis of people with psychosis, a better understanding of the choices behind the utilisation of long-acting injectable treatment in Australia is urgently needed.
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Affiliation(s)
- Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Dan Siskind
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| | - Andrea Phillipou
- Swinburne University of Technology, Melbourne, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,St Vincent's Health Australia, Melbourne, VIC, Australia.,Austin Health, Melbourne, VIC, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - David Castle
- The University of Melbourne, Melbourne, VIC, Australia.,St Vincent's Health Australia, Melbourne, VIC, Australia.,Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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16
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Pae CU, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS. Clinical Benefit and Utility of Switching to Aripiprazole Once Monthly in Patients with Antipsychotic Polypharmacy or Long Acting Injectable Antipsychotics for Patients with Schizophrenia in Routine Practice: A Retrospective, Observation Study. Clin Psychopharmacol Neurosci 2021; 19:233-242. [PMID: 33888652 PMCID: PMC8077057 DOI: 10.9758/cpn.2021.19.2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
Objective In a number of controlled clinical trials and naturalistic studies, aripiprazole once monthly (AOM) has been found to be effective and safe as acute and maintenance treatment options for schizophrenia. However, such clinical data have been presented in selected patient population (i.e., antipsychotic monotherapy, etc.), in particular, clinical information on switching to AOM from antipsychotic polypharmacy and/or other long acting injectable antipsychotics (LAIs) has been scarce till today. Methods The study period was from the first switching day to AOM up to 12 months in patients with antipsychotic polypharmacy (APpoly)/LAIs (baseline, month 3, month 6, and month 12). Available demographics and clinical information were retrieved from electronic medical records (EMRs). Available scores of Global Assessment of Functioning (GAF), Clinical Global Impression-Clinical Benefit (CGI-CB), CGI-severity, Visual Analog Scale on Satisfaction-Patient/Health Professional (VAS-P/HP), and the Positive and Negative Syndrome Scale-Insigh (PANSS-I) scores were also taken from EMR. Proportional change of functional impairment before and after AOM was also captured. Results Data of 18 patients were available. Most commonly used combined APs before AOM were aripiprazole, blonanserin, quetiapine, and risperidone. At least 2 APs (n = 2.4) were combined before AOM. Scores of GAF (10.7% increase), CGI-CB (46.2% decrease), VAS-P (47.8% increase), VAS-HP (40.8% increase), and PANSS-I (27.9% increase) (all p = 0.001) were significantly improved from baseline to month 12, respectively. Approximately 59% of patients improved individual functioning with different level (i.e., employment, back to school, etc.) after AOM treatment at month 12. Conclusion The present study have clearly shown the clinical benefit and utility of switching to AOM for treatment of patients with APpoly/LAIs in routine practice. Subsequent, adequately-powered, well-controlled clinical trials may be necessary to confirm our findings in near future.
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Affiliation(s)
- Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA.,Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
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McEvoy JP, Weiden PJ, Lysaker PH, Sun X, O’Sullivan AK. Long-term effect of aripiprazole lauroxil on health-related quality of life in patients with schizophrenia. BMC Psychiatry 2021; 21:164. [PMID: 33761928 PMCID: PMC7992347 DOI: 10.1186/s12888-021-03124-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/17/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This post hoc analysis of clinical trial data evaluated long-term, self-reported mental and physical health-related quality of life (HRQoL) scores in schizophrenia patients receiving aripiprazole lauroxil (AL), an atypical long-acting injectable (LAI) antipsychotic approved for the treatment of schizophrenia in adults. METHODS The study population included 291 stable schizophrenia outpatients enrolled in 2 consecutive long-term safety studies of AL given every 4 weeks for up to 124 weeks. HRQoL was measured using the SF-36v2® Health Survey (SF-36v2) over the course of the follow-up. The primary outcome was change in SF-36v2 mental component summary (MCS) and physical component summary (PCS) scores from baseline to 124 weeks. To contextualize these scores, descriptive analyses were conducted to compare the scores with available scores for the general population as well as for other populations with chronic medical (ie, hypertension and type 2 diabetes) or psychiatric (ie, depression) conditions. RESULTS Results from this post hoc analysis indicated that the mean MCS score for patients continuing AL improved significantly from baseline over 124 weeks (P < .05, all timepoints), while mean PCS score showed little change over 124 weeks. At baseline, patients had lower (worse) MCS scores than the normed general population, but by week 124, patients had MCS scores comparable to those in the general population. This pattern of change was not observed with PCS scores. Comparison of study MCS scores with those associated with other diseases showed that this schizophrenia cohort had lower scores than those with chronic medical conditions but higher scores than those with depression. PCS scores were higher in the study population than published scores for all reference populations at baseline and week 124. CONCLUSIONS In this post hoc analysis, outpatients with schizophrenia who continued the LAI antipsychotic AL showed gradual and sustained improvement in self-reported mental HRQoL over several years of follow-up, whereas self-reported physical HRQoL did not change. By the end of follow-up, mental health scores of study patients with schizophrenia were comparable to those of the general population and better than those of patients with depression. TRIAL REGISTRATION ClinicalTrials.gov (NCT01626456 [trial registration date: June 15, 2012] and NCT01895452 [trial registration date: July 5, 2013]).
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Affiliation(s)
- Joseph P. McEvoy
- grid.410427.40000 0001 2284 9329Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St. Sebastian Way, EG-1010, Augusta, GA 30912 USA
| | - Peter J. Weiden
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | - Paul H. Lysaker
- grid.280828.80000 0000 9681 3540Roudebush VA Medical Center, Indianapolis, IN USA ,grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
| | - Xiaowu Sun
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
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Lin CH, Chan HY, Hsu CC, Chen FC. Time to rehospitalization in patients with bipolar mania discharged on long-acting injectable or oral antipsychotics. J Affect Disord 2021; 279:292-298. [PMID: 33096327 DOI: 10.1016/j.jad.2020.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/27/2020] [Accepted: 10/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to analyze time to rehospitalization in patients with bipolar mania discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). Additionally, temporal trends in LAI prescription were investigated. METHODS Patients with bipolar mania discharged from the study hospital on antipsychotics between 2006 and 2018 were included. Survival analysis was used to compare time to rehospitalization within one year of discharge between patients discharged on LAIs and OAPs, and between FGA-LAIs (first- generation antipsychotic) and SGA-LAIs (second-generation antipsychotic). The Cochrane-Armitage trend test was used to test whether a temporal trend existed for LAI prescription rates during the study period. RESULTS The LAI group (n = 224) had a significantly lower rehospitalization rate and a significantly longer time to rehospitalization than the OAP group (n = 3836). Rehospitalization rate and time to rehospitalization were not significantly different between patients discharged on FGA-LAIs or SGA-LAIs. The LAI prescription rate grew significantly from 2.20% in 2006 to 11.58% in 2018 (Z = 5.5843, p < 0.0001). The prescription rate of SGA-LAIs also increased significantly (Z = 7.7141, p < 0.0001), but not the prescription rate of FGA-LAIs. LIMITATIONS The treatment allocation is not randomized in this retrospective study. Furthermore, various clinical characteristics were unavailable in our analysis, such as symptom severity, functional impairment, and others. CONCLUSIONS LAIs were significantly superior to OAPs in reducing rehospitalization risk. However, SGA-LAIs were comparable with FGA-LAIs in reducing rehospitalization risk. Use of LAIs increased significantly in discharged patients with bipolar disorder during the study period, especially SGA-LAIs.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chun-Chi Hsu
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| | - Feng-Chua Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Kishi T, Sakuma K, Okuya M, Iwata N. Association between discontinuation due to withdrawal of consent and use of long-acting injectable antipsychotics: A meta-analysis of randomized trials for schizophrenia. J Psychiatr Res 2021; 132:144-150. [PMID: 33096355 DOI: 10.1016/j.jpsychires.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Abstract
We investigated the association between discontinuation due to withdrawal of consent (DWC) in schizophrenia trials and the use of long-acting injectable antipsychotics (LAI-APs). In two categorical meta-analyses of randomized controlled trials, we compared DWC: individual and pooled LAI-APs vs. (1) placebo and (2) oral antipsychotics (OAPs). We also performed conducted a single-group meta-analysis to calculate the average DWC and a meta-regression analysis to examine the association between the results of the meta-analyses and factors related to study design, treatment, and patients. We identified 52 studies (total adult patients = 18,675, LAI-APs = 12,613, placebo = 2,083, and OAPs = 3,979; median study duration = 32 weeks). DWC was higher for LAI-aripiprazole than for the placebo [risk ratio (95% confidence interval) = 1.70 (1.23-2.39)]. Neither pooled nor individual LAI-APs differed from the placebo for fluphenazine, olanzapine, paliperidone, and risperidone or from the OAPs for aripiprazole, fluphenazine, haloperidol, olanzapine, paliperidone, risperidone, and zuclopenthixol. The average DWC of each LAI-AP was as follows: LAI-aripiprazole = 10.98%, LAI-fluphenazine = 7.65%, LAI-flupenthixol = 3.33%, LAI-haloperidol = 6.71%, LAI-olanzapine = 10.50%, LAI-paliperidone = 10.38%, LAI-perphenazine = 7.06%, LAI-risperidone = 10.39%, LAI-zuclopenthixol = 4.45%, pooled LAI-APs = 9.88%, and placebo = 11.17%. Meta-regression analysis demonstrated that publication year (β = 0.02), percentage of males (β = 0.02), and mean age (β = 0.05) were associated with an average DWC for pooled LAI-APs. Study duration (β = -0.03), percentage of males (β = 0.08), and patient status (β = -0.85) were associated with an average DWC for LAI-aripiprazole. Presence of a placebo arm (β = 1.60) was associated with an average DWC for LAI-fluphenazine. LAI-AP use was unlikely to be associated with DWC. Although the LAI-aripiprazole had a higher DWC than did the placebo, its average DWC was similar to other those of LAI-APs.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Makoto Okuya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
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Robinson DG, Subramaniam A, Fearis PJ, Shi R, Walsh M, Hanna LA, Kane JM. Focused Ethnographic Examination of Barriers to Use of Long-Acting Injectable Antipsychotics. Psychiatr Serv 2020; 71:337-342. [PMID: 31847736 DOI: 10.1176/appi.ps.201900236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors designed this project to identify barriers to using long-acting formulations of antipsychotics. METHODS The authors used a focused ethnographic approach. Patients, psychiatrists, nurses, therapists and administrators were interviewed about barriers to use of long-acting injectable (LAI) antipsychotics at six facilities in New York State, as were representatives from insurance firms, a pharmaceutical company, and a national professional organization. Interviews were conducted and analyzed by a central team not affiliated with the institutions. RESULTS Interviews were obtained with 23 patients, 16 psychiatrists, three nurses, 23 therapists, 14 administrators, four insurers, one representative from a pharmaceutical industry, and one representative from a national organization. Major barriers identified from the interviews included restricting discussions about LAI medication to only patients with nonadherence or repeated hospitalizations; inadequate education efforts with patients about LAI antipsychotics; inadequate support for patients making medication decisions; lack of communication within the treatment team about issues relevant to use of LAI formulations by patients; therapists' limited knowledge about LAI antipsychotics, which restricted their role in supporting patients making treatment decisions; psychiatrist concerns about the pharmacologic properties of LAI formulations; lack of clinic infrastructure to support LAI prescriptions; and payer concerns about whether the immediate costs of LAI administration would translate into later potential cost benefits. CONCLUSIONS Effective shared decision making about use of LAI antipsychotics requires that patients receive accurate information and support for their decision making. The training needs and administrative support requirements of all team members should be considered to provide patients with the information and support required.
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Affiliation(s)
- Delbert G Robinson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Anant Subramaniam
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Paul J Fearis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Richard Shi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Megan Walsh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Lauren A Hanna
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - John M Kane
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
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21
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Fiorillo A, Barlati S, Bellomo A, Corrivetti G, Nicolò G, Sampogna G, Stanga V, Veltro F, Maina G, Vita A. The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review. Ann Gen Psychiatry 2020; 19:43. [PMID: 32774442 PMCID: PMC7409631 DOI: 10.1186/s12991-020-00293-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Shared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient's preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient's perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli, Largo Madonna delle Grazie, Naples, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | | | - Giuseppe Nicolò
- Department of Mental Health Colleferro, ASL Roma G, Tivoli, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli, Largo Madonna delle Grazie, Naples, Italy
| | - Valentina Stanga
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Veltro
- Mental Health Department of Campobasso, Campobasso, Italy
| | - Giuseppe Maina
- Department of Neuroscience, University of Torino, Turin, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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22
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Gorwood P, Bouju S, Deal C, Gary C, Delva C, Lancrenon S, Llorca PM. Predictive factors of functional remission in patients with early to mid-stage schizophrenia treated by long acting antipsychotics and the specific role of clinical remission. Psychiatry Res 2019; 281:112560. [PMID: 31521843 DOI: 10.1016/j.psychres.2019.112560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functional remission has become a major therapeutic objective in schizophrenia, but the probability of such positive outcome has a large variability, ranging from 15% to 51%. Additionally, how clinical remission constitutes a prerequisite for functional remission also remains unclear. METHODS A prospective observational study was conducted in French schizophrenic patients who initiated treatment with a long-acting injectable (LAI) after an acute episode. Functional and clinical remissions were assessed using the FROGS and the Andreasen criteria, and the role of clinical remission and predictive factors of functional remission was evaluated. RESULTS Three hundred three patients with schizophrenia (DSM-IV criteria) were followed for 12 months. At 12 months, 45.1% of the patients reached functional remission while 55.1% obtained clinical remission. Clinical remission facilitated functional remission (OR = 14.74), especially in patients with psychosis for less than 5 years (OR = 23.73). Other predictive factors concerned the family environment, education level, employment status, baseline functioning levels and level of insight. CONCLUSIONS About half of patients treated with LAI reached functional remission after one year of follow-up. Reduced clinical symptoms and reaching clinical remission largely favored functional remission. These results stress the importance of continuous and appropriate symptomatic treatment to reach functional remission and maximize recovery chances.
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Affiliation(s)
- Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France; University of Paris, Paris, France; CMME (Sainte-Anne Hospital, GHU Paris), Paris, France.
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23
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Kurokawa S, Kishimoto T, Su KP, Chang JPC, Chang HC, Yu X, Rodrigues-Silva N, Nielsen J, Unadkat A, Castle D, Haddad PM, Rocha D, Gadelha A, Kaliora S, Petrides G, Agid O, Tazawa Y, Takamiya A, Horigome T, Kane JM. Psychiatrists' perceptions of medication adherence among patients with schizophrenia: An international survey. Schizophr Res 2019; 211:105-107. [PMID: 31371039 DOI: 10.1016/j.schres.2019.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Shunya Kurokawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taishiro Kishimoto
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States.
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Jane Pei-Chen Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Hui-Chih Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Xin Yu
- Peking University Sixth Hospital, No.51 Hua Yuan Bei Road, Haidian District, Beijing, 100191, China
| | - Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Cova da Beira University Healthcare Center, Quinta do Alvito, Covilhã, 6200-251, Portugal
| | - Jimmi Nielsen
- Mental health Centre Glostrup, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Anish Unadkat
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - David Castle
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - Peter M Haddad
- Department of Psychiatry, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Deyvis Rocha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Styliani Kaliora
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Georgios Petrides
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, CS 732, Toronto, ON M5T 1R8, Canada
| | - Yuki Tazawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akihiro Takamiya
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiro Horigome
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - John M Kane
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
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Munday J, Greene M, Chang E, Hartry A, Yan T, Broder MS. Early initiation of long-acting injectable antipsychotic treatment is associated with lower hospitalization rates and healthcare costs in patients with schizophrenia: real-world evidence from US claims data. Curr Med Res Opin 2019; 35:1231-1239. [PMID: 30649965 DOI: 10.1080/03007995.2019.1571295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Early initiation of antipsychotic treatment in schizophrenia is associated with improved outcomes. This study aimed to determine if initiation of long-acting injectable (LAI) antipsychotic treatment early in a new schizophrenia episode is associated with lower hospitalization rates and healthcare costs in a real-world setting. Methods: This retrospective (January 1, 2007-June 30, 2016) cohort analysis used claims from Truven Health Analytics MarketScan Commercial, Medicaid, and Medicare Supplemental databases. In adults ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from first recorded schizophrenia diagnosis date to first date of LAI initiation (index date): ≤1 year (early initiators) and >1 year (late initiators). Logistic and general linear regression models were performed to estimate adjusted hospitalization rate and healthcare costs in a 1-year follow-up, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and ED visits, and baseline psychiatric medication use. Results: Of the subjects, 32% (n = 1388) initiated treatment early and 68% (n = 2978) initiated treatment later. In risk-adjusted models, all-cause hospitalization rates were 22.2% (95% CI = 19.9-24.6%) in early initiators and 26.9% (95% CI = 25.2-28.7%) in late initiators (p = .002). Of early initiators, 14.1% (95% CI = 12.3-16.1%) had a psychiatric hospitalization vs 19.2% (95% CI = 17.7-20.8%) of late initiators (p < .001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95% CI) = $21,545 (20,355-22,734) vs $24,132 (23,330-24,933)] (p < .001). Conclusions: LAI initiation within 1 year of a new schizophrenia episode led to lower hospitalization rates and healthcare costs compared with LAI initiation more than 1 year after a new episode.
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Affiliation(s)
- Jennifer Munday
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Mallik Greene
- b Health Economics & Outcomes Research , Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA
| | - Eunice Chang
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Ann Hartry
- c Health Economics and Outcomes , Lundbeck, LLC , Deerfield , IL , USA
| | - Tingjian Yan
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Michael S Broder
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
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Pompili M, Orsolini L, Lamis DA, Goldsmith DR, Nardella A, Falcone G, Corigliano V, Luciano M, Fiorillo A. Suicide Prevention in Schizophrenia: Do Long-Acting Injectable Antipsychotics (LAIs) have a Role? CNS Neurol Disord Drug Targets 2018; 16:454-462. [PMID: 28240189 DOI: 10.2174/1871527316666170223163629] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/02/2017] [Accepted: 02/04/2017] [Indexed: 11/22/2022]
Abstract
Suicide risk is a major cause of death among patients with schizophrenia. Death by suicide has been reported in approximately 5% of schizophrenia patients although this figure appears to be an underestimate of the problem. A number of risk factors are routinely reported as associated with suicide risk among these patients, some of which are modifiable by targeted therapeutic strategies. Clozapine is the only compound that gathered evidence as an effective treatment for reducing suicide risk in schizophrenia. Long-Acting Injectable Antipsychotics (LAIs) have a range of advantages in terms of efficacy, safety and tolerability in the treatment of schizophrenia, and one area of interest is whether LAI-treatment may decrease suicidality by indirectly acting on a range of risk factors for suicide specific to schizophrenia patients. This background encouraged the present review of research pertaining to LAIs in relation to modifiable risk factors for suicide in schizophrenia. We viewed our task as gathering, speculating and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Laura Orsolini
- University of Hertfordshire, Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, United Kingdom
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Adele Nardella
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Falcone
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Corigliano
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Jang S, Woo J. Five Month-Persistent Extrapyramidal Symptoms following a Single Injection of Paliperidone Palmitate: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:288-291. [PMID: 28783941 PMCID: PMC5565081 DOI: 10.9758/cpn.2017.15.3.288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022]
Abstract
Long-acting injectable (LAI) antipsychotics are useful in the treatments for schizophrenic patients with poor adherence due to their maintaining feature of therapeutic plasma level without daily administrations. However, their long-lasting property can cause complicated problems such as a long-lasting side effect. We report a patient who experienced LAI-induced extrapyramidal symptoms (EPSs) for 5 months after a single injection. During that period, every trial to ameliorate this condition turned out to be a failure. The 3-month formulation of paliperidone palmitate is now close at hand. We have to be aware of possible long-lasting adverse events and confirm the tolerability to LAI before use.
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Affiliation(s)
- Seoyoung Jang
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea
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27
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Ostuzzi G, Bighelli I, So R, Furukawa TA, Barbui C. Does formulation matter? A systematic review and meta-analysis of oral versus long-acting antipsychotic studies. Schizophr Res 2017; 183:10-21. [PMID: 27866695 DOI: 10.1016/j.schres.2016.11.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 01/07/2023]
Abstract
Recently, many authors highlighted the potential advantages of a broader prescription of long-acting injectable antipsychotics (LAIs) based on various assumptions, including favorable pharmacokinetic features. In this systematic review, data from randomized controlled trials comparing LAIs versus the oral formulation of the same antipsychotic were meta-analyzed in order to ascertain whether the route of administration may be associated with a different efficacy and tolerability profile. Of 21 included studies, 18 contributed to the meta-analysis, providing data for risperidone, olanzapine, aripiprazole, zuclopenthixol, fluphenazine and haloperidol. For all drugs, the number of dropouts for any reason (primary outcome) did not differ between the two formulations, except for a small effect in favor of LAI aripiprazole (2 comparisons; 986 patients; relative risk (RR) 0.78; 95% confidence interval (CI) 0.64 to 0.95). Similarly, no differences emerged in terms of dropouts for adverse events, extrapyramidal symptoms, prolactin increase (except for a small advantage for LAI risperidone), weight gain, non-response rate, relapse rate, and dropouts for inefficacy (except for a small advantage for oral olanzapine). Data on aripiprazole proved to be of high quality according to the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation), therefore we are confident that the effect estimate is close to the true effect. Data on risperidone were of moderate quality, while data on olanzapine, fluphenazine, zuclopenthixol and haloperidol were of low quality. In conclusion, there is no robust evidence to support doctors in choosing LAI instead of oral formulations in order to obtain better tolerability and efficacy.
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Affiliation(s)
- Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Irene Bighelli
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany.
| | - Ryuhei So
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Kishi T, Oya K, Iwata N. Long-acting injectable antipsychotics for the prevention of relapse in patients with recent-onset psychotic disorders: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Res 2016; 246:750-5. [PMID: 27863801 DOI: 10.1016/j.psychres.2016.10.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/29/2016] [Accepted: 10/25/2016] [Indexed: 11/23/2022]
Abstract
This meta-analysis of randomized controlled trials (RCTs) investigated the advantages of long-acting injectable antipsychotics (LAI-APs) over oral antipsychotics (OAPs) with regard to efficacy and safety for patients with recent-onset psychotic disorders. Effect sizes and 95% confidence intervals (95%CIs) were calculated. We identified five RCTs (1022 patients, mean study duration=18±7.59 months) that compared LAI-APs (paliperidone or risperidone) with OAPs. Pooled LAI-APs did not outperform OAPs in terms of the preventing of relapse (N=3, n=875). However, there was significant heterogeneity (I2=76%), with one study showing no superiority of LAI-APs over OAPs [Malla 2013: risk ratio (RR)=1.83, 95%CI=0.70-4.77, n=77] and the other two studies showing LAI-APs to be superior [Schreiner 2015: [RR=0.71, 95%CI=0.51-0.97, number needed to treat (NNT)=-17, n=715, Subotnik 2015: RR=0.15, 95%CI=0.04-0.63, NNT=-4, n=83]. Pooling the studies, there were no significant differences between LAI-APs and OAPs in the improvement of Positive and Negative Syndrome Scale scores or in discontinuation due to all-cause, adverse events (AEs), and death, but LAI-APs outperformed OAPs in terms of discontinuation due to inefficacy (RR=0.34, NNT=-50) and nonadherence (RR=0.30, NNT=-33). However, the LAI-APs were associated with a higher incidence of at least one AE (RR=1.13) and tremor (RR=2.38) compared with OAPs.
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Misawa F, Kishimoto T, Hagi K, Kane JM, Correll CU. Safety and tolerability of long-acting injectable versus oral antipsychotics: A meta-analysis of randomized controlled studies comparing the same antipsychotics. Schizophr Res 2016; 176:220-30. [PMID: 27499361 DOI: 10.1016/j.schres.2016.07.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to assess whether long-acting injectable antipsychotics (LAIs), which are initiated in a loading strategy or overlapping with oral antipsychotics (OAPs) and which cannot be stopped immediately, are associated with greater safety/tolerability issues than OAPs. METHOD Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing LAIs and OAPs, including only LAI-OAP pairs of the same OAP (allowing oral risperidone and paliperidone as comparators for either risperidone or paliperidone LAI). Primary outcome was treatment discontinuation due to adverse events. Secondary outcomes included serious adverse events, death, ≥1 adverse event and individual adverse event rates. RESULTS Across 16 RCTs (n=4902, mean age=36.4years, males=65.8%, schizophrenia=99.1%) reporting on 119 adverse event outcomes, 55 (46.2%) adverse events were reported by ≥2 studies allowing a formal meta-analysis. Out of all 119 reported adverse events, LAIs and OAPs did not differ significantly regarding 115 (96.6%). LAIs were similar to OAPs regarding the frequency of treatment discontinuation due to adverse events, serious adverse events, all-cause death and death for reasons excluding accident or suicide. Compared to OAPs, LAIs were associated with significantly more akinesia, low-density lipoprotein cholesterol change and anxiety. Conversely, LAIs were associated with significantly lower prolactin change. CONCLUSION LAIs and OAPs did not differ on all serious and >90% of individual adverse events. However, more studies focusing on adverse event frequencies, severity and time course associated with LAI vs OAP formulations of the same antipsychotic are needed. Additionally, adverse events data for LAIs after stopping overlapping oral antipsychotic treatment are needed.
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Wu CS, Hsieh MH, Tang CH, Chang CJ. Comparative effectiveness of long-acting injectable risperidone vs. long-acting injectable first-generation antipsychotics in bipolar disorder. J Affect Disord 2016; 197:189-95. [PMID: 26994437 DOI: 10.1016/j.jad.2016.03.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/03/2016] [Accepted: 03/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the treatment effectiveness between long-acting injectable risperidone and long-acting injectable first-generation antipsychotics among patients with bipolar disorder. METHOD We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. Patients with bipolar disorder aged 15 years or higher, who were newly administered long-acting injectable antipsychotics between June 1, 2004 and December 31, 2011 were included. The clinical outcome indexes were hospitalization for any mood, manic/mixed, or depressive episodes. In addition, the all-cause discontinuation of long-acting injectable antipsychotic treatment was also assessed. RESULTS A total of 3916 patients with bipolar disorder were extracted. Compared with risperidone, the use of first-generation antipsychotics was associated with a higher rate of hospitalization for any mood episode and major depressive episode. However, there was no statistically significant difference in treatment discontinuation rate between risperidone and first-generation antipsychotics. LIMITATIONS Information for the severity of mood symptoms, social support, life style, neurological and metabolic adverse effect was not available in this database. In addition, we only measured severe mood episodes with hospitalization as our outcome index. It may not be possible to generalize our findings to mild mood episodes. CONCLUSIONS Our findings suggested that patients treated with long-acting injectable risperidone might be superior to first-generation antipsychotics in the rate of psychiatric hospitalization.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Ching-Jui Chang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
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Wu CS, Cheng IC, Feng J, Chen CL. Comparison of treatment effectiveness and medical costs for different long-acting injectable antipsychotics in patients with schizophrenia in Taiwan: A nationwide population-based cohort study. Schizophr Res 2016; 173:37-44. [PMID: 26987938 DOI: 10.1016/j.schres.2016.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the comparative effectiveness and medical costs of five long-acting injectable (LAI) antipsychotics, flupentixol, fluphenazine, haloperidol, risperidone, and clopentixol/zuclopentixol, in patients with schizophrenia. METHOD We conducted a retrospective cohort study of patients with schizophrenia using data from Taiwan's National Health Insurance Research Database. Patients aged 15years or older who began treatment with LAI antipsychotics between June 1, 2004 and December 31, 2008 were enrolled and followed for 1year. We evaluated the medical costs and treatment effectiveness, which was assessed using the rates of treatment discontinuation, psychiatric hospitalization, and emergency department visits. Risperidone was used as a reference group. RESULTS Compared to risperidone, flupentixol was associated with higher hazard ratios of treatment discontinuation and psychiatric hospitalization, fluphenazine was associated with higher hazard ratios of treatment discontinuation, and haloperidol was associated with higher rates of psychiatric hospitalization and emergence department visits. However, fluphenazine, flupentixol, and haloperidol were associated with lower medical costs compared to risperidone. Clopentixol/zuclopentixol was inferior to risperidone in treatment effectiveness and medical cost. CONCLUSIONS Our findings suggest that patients taking the LAI risperidone may be more effective in some but not all outcome measures; however, risperidone was also associated with higher medical costs in the Taiwanese healthcare setting.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Chih Cheng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung Feng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Lin Chen
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Williams W, McKinney C, Martinez L, Benson C. Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery. J Med Econ 2016; 19:469-76. [PMID: 26671481 DOI: 10.3111/13696998.2015.1131989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. METHODS Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. RESULTS A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p < 0.05), an overall increase (p < 0.01), and an increased rate of change (p < 0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period. LIMITATIONS This study contained a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.
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Affiliation(s)
| | | | - Larry Martinez
- b b Janssen Scientific Affairs , LLC , Titusville , NJ , USA
| | - Carmela Benson
- b b Janssen Scientific Affairs , LLC , Titusville , NJ , USA
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Chou YH, Chu PC, Wu SW, Lee JC, Lee YH, Sun IW, Chang CL, Huang CL, Liu IC, Tsai CF, Yen YC. A Systemic Review and Experts' Consensus for Long-acting Injectable Antipsychotics in Bipolar Disorder. Clin Psychopharmacol Neurosci 2015; 13:121-8. [PMID: 26243837 PMCID: PMC4540044 DOI: 10.9758/cpn.2015.13.2.121] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023]
Abstract
Bipolar disorder (BD) is a major psychiatric disorder that is easily misdiagnosed. Patient adherence to a treatment regimen is of utmost importance for successful outcomes in BD. Several trials of antipsychotics suggested that depot antipsychotics, including long-acting first- and second-generation agents, are effective in preventing non-adherence, partial adherence, and in reducing relapse in BD. Various long-acting injectable (LAI) antipsychotics are available, including fluphenazine decanoate, haloperidol decanoate, olanzapine pamoate, risperidone microspheres, paliperidone palmitate, and aripiprazole monohydrate. Due to the increasing number of BD patients receiving LAI antipsychotics, treatment guidelines have been developed. However, the clinical applicability of LAI antipsychotics remains a global cause for concern, particularly in Asian countries. Expert physicians from Taiwan participated in a consensus meeting, which was held to review key areas based on both current literature and clinical practice. The purpose of this meeting was to generate a practical and implementable set of recommendations for LAI antipsychotic use to treat BD; target patient groups, dosage, administration, and adverse effects were considered. Experts recommended using LAI antipsychotics in patients with schizophrenia, rapid cycling BD, BD I, and bipolar-type schizoaffective disorder. LAI antipsychotic use was recommended in BD patients with the following characteristics: multiple episodes and low adherence; seldom yet serious episodes; low adherence potential per a physician’s clinical judgment; preference for injectable agents over oral agents; and multiple oral agent users still experiencing residual symptoms.
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Affiliation(s)
- Yuan Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital & National Yang Ming University, Taipei, Taiwan
| | - Po-Chung Chu
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Szu-Wei Wu
- Department of Psychiatry, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Jen-Chin Lee
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yi-Hsuan Lee
- Department of Psychiatry, Tainan Municipal Hospital, Tainan, Taiwan
| | - I-Wen Sun
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chen-Lin Chang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chien-Liang Huang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - I-Chao Liu
- Department of Psychiatry, Cardinal Tien Hospital, Taipei, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan
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Benson CJ, Joshi K, Lapane KL, Fastenau J. Evaluation of a comprehensive information and assistance program for patients with schizophrenia treated with long-acting injectable antipsychotics. Curr Med Res Opin 2015; 31:1437-48. [PMID: 25978698 DOI: 10.1185/03007995.2015.1050365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE While atypical long-acting injectable antipsychotics (LAIs) offer the potential for increased adherence, access to medication poses challenges that may hinder their use. Janssen Connect * *Janssen Connect is a registered trade name of Janssen Scientific Affairs, LLC, Titusville, NJ, USA. (JC), a comprehensive information and assistance program, was designed to help patients who received a Janssen LAI initiate and maintain treatment after their health care professional (HCP) determined that the medication was the most clinically appropriate option. We conducted a formative and impact evaluation on early medication adherence of patients enrolled in JC and prescribed paliperidone palmitate. METHODS Using the program administrative files (December 2010-April 2014), 9354 patients whose HCP ordered paliperidone palmitate were included. Patient demographics, clinical characteristics, and request of JC program offerings were reported overall, and compared between patients requesting the injection center versus those who did not. Medication adherence based on the first 6 months of treatment while in the program and defined as achieving ≥80% proportion of days covered (PDC) was measured for patients receiving ≥2 paliperidone palmitate injections (n = 2659). Logistic models evaluated the association between requests for injection centers on medication adherence. RESULTS Mean age of program enrollees was 40.6 (standard deviation = 13.9 years), 59.3% were men, and 42.5% were Medicare covered. While in the program, 79.9% did not experience a medication gap of ≥7 weeks and 87.0% achieved adherence. Injection center request was associated with medication adherence (adjusted odds ratio (aOR) ≤5 months: 0.03; 95% confidence interval (CI): 0.02-0.05; ≥6 months: aOR: 4.16; 95% CI: 2.72-6.36). LIMITATIONS The data sources used were designed for program implementation and not for research purposes. CONCLUSIONS The high percentage of patients requesting injection center support and medication shipment in addition to other insurance-related program offerings signals the need for and value of a comprehensive support program for patients seeking LAI therapy. Providing patients with the option of alternative and more conveniently located injection centers may help them start and maintain their treatment.
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Samalin L, Charpeaud T, Llorca PM. [Aripiprazole long-acting for the maintenance treatment of schizophrenia.]. Encephale 2014; 40:487-494. [PMID: 25453734 DOI: 10.1016/j.encep.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
Antipsychotics are the cornerstone for the maintenance treatment of schizophrenia patients. Their long-acting formulations are helpful for preventing relapses through improvement of adherence to medication and a better pharmacokinetic coverage. However, their use is often reserved for refractory or non-observant clinical forms because of limitations among both clinicians and patients. The development of a new formulation of long-acting injectable aripiprazole administered every 4 weeks is a new option. Two randomized controlled trials vs. placebo and vs. oral aripiprazole respectively show a superiority and non-inferiority in terms of relapse prevention. Meanwhile, a mirror-image study demonstrates fewer hospitalizations. The safety profile is comparable to the oral formulation, particularly in terms of metabolic and neurological side-effects. As mentioned in various professional recommendations, long-acting injectable antipsychotics, so long-acting injectable aripiprazole, are one of the major strategies of the maintenance treatment for patients with schizophrenia.
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Affiliation(s)
- L Samalin
- Service de psychiatrie B, CHU de Clermont-Ferrand, EA 7280, université d'Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - T Charpeaud
- Service de psychiatrie B, CHU de Clermont-Ferrand, EA 7280, université d'Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P-M Llorca
- Service de psychiatrie B, CHU de Clermont-Ferrand, EA 7280, université d'Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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