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Turkoz I, Daskiran M, Siddiqui U, Knight RK, Johnston KL, Correll CU. Relapse Rates With Paliperidone Palmitate in Adult Patients With Schizophrenia: Results for the 6-Month Formulation From an Open-label Extension Study Compared to Real-World Data for the 1-Month and 3-Month Formulations. Int J Neuropsychopharmacol 2024; 27:pyad067. [PMID: 38300235 PMCID: PMC10873782 DOI: 10.1093/ijnp/pyad067] [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: 07/28/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The 3 paliperidone palmitate (PP) long-acting injectable antipsychotic formulations, PP 1-month (PP1M), PP 3-month (PP3M), and PP 6-month (PP6M), have shown to reduce the risk of relapse in schizophrenia. The current phase-4 study constructed external comparator arms (ECAs) using real-world data for PP3M and PP1M and compared relapse prevention rates with PP6M from an open-label extension (OLE) study in adult patients with schizophrenia. METHODS PP6M data were derived from a single-arm, 24-month, OLE study (NCT04072575), which included patients with schizophrenia who completed a 12-month randomized, double-blind, noninferiority, phase-3 study (NCT03345342) without relapse. Patients in the PP3M and PP1M ECAs were identified from the IBM® MarketScan® Multistate Medicaid Database based on similar eligibility criteria as the PP6M cohort. RESULTS A total of 178 patients were included in each cohort following propensity score matching. Most patients were men (>70%; mean age: 39-41 years). Time to relapse (primary analysis based on Kaplan-Meier estimates) was significantly delayed in the PP6M cohort (P < .001, log-rank test). The relapse rate was lower in the PP6M cohort (3.9%) vs PP3M (20.2%) and PP1M (29.8%) cohorts. Risk of relapse decreased significantly (P < .001) by 82% for PP6M vs PP3M (HR = 0.18 [95% CI = 0.08 to 0.40]), 89% for PP6M vs PP1M (HR = 0.11 [0.05 to 0.25]), and 35% for PP3M vs PP1M (HR = 0.65 [0.42 to 0.99]; P = .043). Sensitivity analysis confirmed findings from the primary analysis. Although the ECAs were matched to mimic the characteristics of the PP6M cohort, heterogeneity between the groups could exist due to factors including prior study participation, unmeasured confounders, variations in data capture and quality, and completeness of clinical information. CONCLUSIONS In a clinical trial setting, PP6M significantly delayed time to relapse and demonstrated lower relapse rates compared with PP3M and PP1M treatments in real-world settings among adult patients with schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04072575; EudraCT number: 2018-004532-30.
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Affiliation(s)
- Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Uzma Siddiqui
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - R Karl Knight
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Christoph U Correll
- Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofestra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
- Charité – Universitätsmedizin, Berlin, Department of Child and Adolescent Psychiatry, Germany
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Savitz AJ, Xu H, Gopal S, Nuamah I, Ravenstijn P, Janik A, Schotte A, Hough D, Fleischhacker WW. Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized, Multicenter, Double-Blind, Noninferiority Study. Int J Neuropsychopharmacol 2016; 19:pyw018. [PMID: 26902950 PMCID: PMC4966278 DOI: 10.1093/ijnp/pyw018] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/12/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This double-blind, parallel-group, multicenter, phase-3 study was designed to test the noninferiority of paliperidone palmitate 3-month formulation (PP3M) to the currently marketed 1-month formulation (PP1M) in patients (age 18-70 years) with schizophrenia, previously stabilized on PP1M. METHODS After screening (≤3 weeks) and a 17-week, flexible-dosed, open-label phase (PP1M: day 1 [150mg eq. deltoid], day 8 [100mg eq. deltoid.], weeks 5, 9, and 13 [50, 75, 100, or 150mg eq., deltoid/gluteal]), clinically stable patients were randomized (1:1) to PP3M (fixed-dose, 175, 263, 350, or 525mg eq. deltoid/gluteal) or PP1M (fixed-dose, 50, 75, 100, or 150mg eq. deltoid/gluteal) for a 48-week double-blind phase. RESULTS Overall, 1016/1429 open-label patients entered the double-blind phase (PP3M: n=504; PP1M: n=512) and 842 completed it (including patients with relapse). PP3M was noninferior to PP1M: relapse rates were similar in both groups (PP3M: n=37, 8%; PP1M: n=45, 9%; difference in relapse-free rate: 1.2% [95% CI:-2.7%; 5.1%]) based on Kaplan-Meier estimates (primary efficacy). Secondary endpoint results (changes from double-blind baseline in positive and negative symptom score total and subscale scores, Clinical Global Impression-Severity, and Personal and Social Performance scores) were consistent with primary endpoint results. No clinically relevant differences were observed in pharmacokinetic exposures between PP3M and PP1M. Both groups had similar tolerability profiles; increased weight was the most common treatment-emergent adverse event (double-blind phase; 21% each). No new safety signals were detected. CONCLUSION Taken together, PP3M with its 3-month dosing interval is a unique option for relapse prevention in schizophrenia.
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Affiliation(s)
- Adam J Savitz
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker).
| | - Haiyan Xu
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Srihari Gopal
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Isaac Nuamah
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Paulien Ravenstijn
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Adam Janik
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Alain Schotte
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - David Hough
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Wolfgang W Fleischhacker
- Janssen Research & Development, LLC, Raritan, New Jersey (Drs Savitz, Xu, Gopal, Nuamah, Ravenstijn, Janik, Schotte, and Hough); Medical University, Innsbruck, Austria (Dr Fleischhacker)
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