Comparison of treatment retention between risperidone long‐acting injection, paliperidone palmitate, and aripiprazole once‐monthly in elderly patients with schizophrenia

INTRODUCTION:Existing evidence on clinical and economic effectiveness of one long-acting injectable antipsychotic (LAI) versus another in successful management of schizophrenia is scarce. The study was conducted to compare all-cause inpatient healthcare utilization and associated costs among Medicaid patients with schizophrenia who initiated LAIs.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database. Schizophrenia patients >18 years with at least one claim for one of the following LAI were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, fluphenazine, haloperidol, paliperidone palmitate, and risperidone. The first day of initiating an LAI was considered the index date. Patients were followed for 1 year from index date. Logistic and general linear regression models were used to estimate risk of inpatient hospitalization and associated costs during follow up.RESULTS:Of the identified Medicaid patients with schizophrenia, 1,672 (36.7 percent) initiated an LAI: 44.0 percent received paliperidone, 26.4 percent haloperidol, 13.8 percent risperidone, 9.2 percent aripiprazole, and 6.6 percent fluphenazine. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.51 (1.05 - 2.16)] and risperidone [OR (95 percent CI): 1.58 (1.07 - 2.33)] cohorts. Fluphenazine and paliperidone palmitate cohorts also had higher risk of having any inpatient hospitalizations compared with aripiprazole, but the differences were not statistically significant (p>.05). Among LAI initiators with any inpatient hospitalizations, the adjusted mean inpatient costs were lowest in the aripiprazole cohort (USD25,616), followed by haloperidol (USD30,811), paliperidone (USD30,833), risperidone (USD31,584), and fluphenazine (USD37,338), although differences were not statistically significant.CONCLUSIONS:Our study findings highlight the value of aripiprazole in reducing inpatient hospitalizations and associated costs among patients with schizophrenia. However, our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.

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Discontinuation and relapse with paliperidone palmitate three-monthly for maintenance of schizophrenia: Two year follow-up of use in clinical practice

Journal of Psychopharmacology ◽

10.1177/02698811211009794 ◽

2021 ◽

pp. 026988112110097

Author(s):

Phoebe Wallman ◽

Ivana Clark ◽

David Taylor

Keyword(s):

Clinical Practice ◽

Treatment Duration ◽

Maintenance Treatment ◽

Clinical Care ◽

Paliperidone Palmitate ◽

Reduce Risk ◽

Patient Refusal ◽

Long Acting ◽

Post Hoc

Background: The use of antipsychotic long-acting injections (LAI) aims to reduce risk of relapse and hospitalisation in patients with schizophrenia compared with oral medication. Paliperidone palmitate is currently the only LAI that can be administered at three-monthly intervals for maintenance treatment of schizophrenia. Aim: This prospective study aimed to evaluate relapse and continuation in licensed use of paliperidone palmitate three-monthly (PP3M) over a 2-year follow-up in clinical practice. Method: Non-interventional, observational study of patients treated in the South London and The Maudsley NHS Foundation Trust. Results: A total of 166 patients initiated on PP3M, 55 were excluded from the study (non-F20 diagnosis ( n = 43); F20 >65 years old ( n = 12)). Of the 111 patients included, 67 (60%) continued PP3M for 2 years. Overall 102 patients received more than one dose of PP3M and 92 (90%) remained on the same dose of PP3M for the whole of their treatment duration. Relapse (defined as a step-up in clinical care) occurred in eight patients (7%) while on PP3M. The most common reason for discontinuation was patient refusal and the most frequent medication prescribed after discontinuation was paliperidone palmitate one-monthly (PP1M). Post hoc, we analysed outcome in those continuing any form of PPLAI (those continuing with PP3M and those switching back to PP1M). Continuation over 2 years with any PPLAI formulation was 73% (81/111) and relapse was recorded in 9% (10/111). Conclusion: Overall, PP3M was an effective maintenance treatment for schizophrenia after stabilisation on PP1M in a clinical setting.

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P.7.d.012 Paliperidone palmitate long-acting injection in adolescents: report of two cases

European Neuropsychopharmacology ◽

10.1016/s0924-977x(13)70964-7 ◽

2013 ◽

Vol 23 ◽

pp. S606-S607 ◽

Cited By ~ 1

Author(s):

M. Fabrega Ribera ◽

S. Garcia Chulbi ◽

G. Sugranyes Ernest ◽

I. Baeza Pertegaz

Keyword(s):

Paliperidone Palmitate ◽

Long Acting

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Effectiveness of paliperidone palmitate one-month long-acting injection in obese vs. non-obese patients

Comprehensive Psychiatry ◽

10.1016/j.comppsych.2021.152269 ◽

2021 ◽

pp. 152269

Author(s):

Charles Dorflinger ◽

Colleen LeHew ◽

Heather Carey ◽

Jennifer Roche-Desilets ◽

Christopher J. Burant

Keyword(s):

Paliperidone Palmitate ◽

Obese Patients ◽

Long Acting

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Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

European Psychiatry ◽

10.1016/j.eurpsy.2008.12.002 ◽

2009 ◽

Vol 24 (5) ◽

pp. 287-296 ◽

Cited By ~ 95

Author(s):

J.M. Olivares ◽

A. Rodriguez-Morales ◽

J. Diels ◽

M. Povey ◽

A. Jacobs ◽

...

Keyword(s):

Observational Study ◽

Treatment Adherence ◽

Prospective Observational Study ◽

Clinical Symptoms ◽

Retrospective Chart Review ◽

Treatment Retention ◽

Severity Scores ◽

Long Term Treatment ◽

Long Acting

AbstractBackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (−1.14 for RLAI versus −0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

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