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Kurariya A, Purohith AN, Shenoy S, Bhandary RP, Sharma PSVN. Acute Urinary Retention Associated with Olanzapine Long-acting Injection: A Case Report. Indian J Psychol Med 2024; 46:279-280. [PMID: 38699762 PMCID: PMC11062305 DOI: 10.1177/02537176231222566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Affiliation(s)
- Astut Kurariya
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhiram N. Purohith
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sonia Shenoy
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajeshkrishna P. Bhandary
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Oh J, Oh J, Kim DW, Youn H, Kim SH, Kim SI, Chung IW, Wang KS, Kim M, Paik JW, Koh MJ, Lee Y, Choi SY, Kim JJ. Effects of Long-acting Injectable 3-Monthly Paliperidone Palmitate on the Clinical and Social Performance of Patients with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:126-134. [PMID: 36700319 PMCID: PMC9889906 DOI: 10.9758/cpn.2023.21.1.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 01/27/2023]
Abstract
Objective To investigate the effects of long-acting injectable 3-monthly paliperidone palmitate on the clinical and social functioning of patients with schizophrenia. Methods This study enrolled patients with schizophrenia receiving long-acting injectable 1-monthly paliperidone palmitate for at least 4 months and who subsequently received 3-monthly paliperidone palmitate. Accordingly, 418 patients were followed up for 24 weeks. Their clinical symptoms and social functioning were measured using the Clinical Global Impression-Severity of Illness and Personal and Social Performance scales. Results The Personal and Social Performance total score was significantly higher after 3-monthly paliperidone palmitate treatment than at baseline (baseline vs. week 24: 54.3 ± 18.0 vs. 61.0 ± 14.5 [mean ± standard deviation]; p < 0.001; Wilcoxon signed-rank test); the proportion of patients in the mildly ill group (scores 71-100) also increased significantly (baseline vs. week 24: 16.5% vs. 20.6%; p < 0.001; McNemar-Bowker test). The mean Clinical Global Impression-Severity of Illness score decreased significantly (baseline vs. week 24: 3.7 ± 1.0 vs. 3.4 ± 0.9; p < 0.001; Wilcoxon signed-rank test), as did the proportion of patients in the severely ill group (baseline vs. week 24: 4.1% vs. 2.1%; p < 0.001; McNemar-Bowker test). Conclusion Continuous 3-monthly paliperidone palmitate treatment significantly enhances the personal and social performance of patients with schizophrenia and reduces the proportion of those with severe illness. These findings suggest that long-acting injectable antipsychotic administration at intervals longer than 1 month might improve the social functioning of and promote return to activities of daily living in patients with schizophrenia.
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Affiliation(s)
- Jihoon Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihye Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Soo In Kim
- Department of Psychiatry, Ewha Womans University College of Medicine, Seoul, Korea
| | - In Won Chung
- Institute of Spirituality and Mental Health, St. Andrew’s Hospital, Icheon, Korea
| | - Kuan Shu Wang
- Department of Psychiatry, Maryknoll Medical Center, Busan, Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | - Yoosun Lee
- Medical Affairs, Janssen Korea, Seoul, Korea
| | | | - Jung-Jin Kim
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Jung-Jin Kim Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-3899-5579
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Bogers JPAM, Hambarian G, Walburgh Schmidt N, Vermeulen JM, de Haan L. Risk Factors for Psychotic Relapse After Dose Reduction or Discontinuation of Antipsychotics in Patients With Chronic Schizophrenia. A Meta-Analysis of Randomized Controlled Trials. Schizophr Bull 2023; 49:11-23. [PMID: 36200866 PMCID: PMC9810020 DOI: 10.1093/schbul/sbac138] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although maintenance treatment with antipsychotics protects against psychotic relapse, high doses may hamper recovery. Therefore, dose reduction or discontinuation may be considered in patients with chronic schizophrenia. Here, we identified risk factors for psychotic relapse when doses are reduced. STUDY DESIGN We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through January 2021 and reviewed randomized controlled trials (RCTs) that reported relapse rates after antipsychotic dose reduction or discontinuation in patients with chronic schizophrenia. We calculated relative risks (RRs) with 95% confidence intervals (CIs) per person-year and sought to identify potential risk factors for relapse. The study is registered with PROSPERO (CRD42017058296). STUDY RESULTS Forty-seven RCTs (54 patient cohorts, 1746 person-years) were included. The RR for psychotic relapse with dose reduction/discontinuation versus maintenance treatment was 2.3 per person-year (95% CI: 1.9 to 2.8). The RR was higher with antipsychotic discontinuation, dose reduction to less than 3-5 mg haloperidol equivalent (HE), or relatively rapid dose reduction (<10 weeks). The RR was lower with long-acting injectable agents versus oral antipsychotic dose reduction. Other factors that increased the risk of psychotic relapse were younger age and short follow-up time. CONCLUSIONS Clinicians should take several risk factors for psychotic relapse into account when considering dose reduction in patients with chronic schizophrenia. Studies of a relatively fast reduction in antipsychotic dose support a minimum dose of 3-5 mg HE. However, if the dose is tapered more gradually, relapses related to medication withdrawal might be avoided, possibly enabling lower-end doses to be achieved.
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Affiliation(s)
- Jan P A M Bogers
- High Care Clinics and Rivierduinen Academy, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | | | | | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Cicala G, de Filippis R, Barbieri MA, Cutroneo PM, De Fazio P, Schoretsanitis G, Spina E. Tolerability profile of paliperidone palmitate formulations: A pharmacovigilance analysis of the EUDRAVigilance database. Front Psychiatry 2023; 14:1130636. [PMID: 37091708 PMCID: PMC10116827 DOI: 10.3389/fpsyt.2023.1130636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Long-acting injectable antipsychotics (LAIs) have proven to be effective in the maintenance treatment of patients suffering from schizophrenia, and their safety and tolerability profiles represent a key factor in their long-term use and choice in clinical practice. Paliperidone palmitate (PP) is the only second-generation LAI (SGA-LAI), available in both one- (PP1M) and 3-month (PP3M) formulations. However, real-world prospective studies on PP1M and PP3M are still few and mostly conducted on small samples. In this context, we aimed to better define the safety and tolerability profile of PP using real world pharmacovigilance data. Methods We retrospectively analyzed the publicly available data regarding Individual Case Safety Reports (ICSRs), presenting PP1M and/or PP3M as suspected drugs, reported on EUDRAVigilance between 2011 and June 30th, 2022. ICSRs relative to at least one SGA-LAI other than PP, reported between 2003 and June 30th, 2022, were also examined as reference group. Data were evaluated with a descriptive analysis, and then, as disproportionality measures, crude reporting odds ratio (ROR) and 95% confidence interval (CI) were calculated. Results A total of 8,152 ICSRs met the inclusion criteria, of those 77.7% (n = 6,332) presented as suspected drug PP1M, 21.2% (n = 1,731) PP3M, while 89 cases indicated both PP1M and PP3M. Significantly higher probabilities of reporting in PP-related reports were observed for the primary Standardized MedDRA Queries "Sexual Dysfunctions" (ROR = 1.45; 95% CI 1.23-1.70), "Haemodynamic oedema, effusions and fluid overload" (ROR = 1.42; 1.18-1.70), as well as "Fertility disorders" (ROR = 2.69; 1.51-4.80). Discussion Our analysis indicates that the tolerability and safety profiles of PP are in line with what is known for the other SGA-LAIs. However, differences regarding endocrine system ADRs have been noticed. The results presented in this work do not discourage the prescription of SGA-LAI formulations but aim to enhance their safety.
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Affiliation(s)
- Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Correspondence: Giuseppe Cicala,
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, United States
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, United States
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Sicilian Regional Pharmacovigilance Center, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
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Zhdanava M, Starr HL, Lefebvre P, Totev TI, Shah A, Sheng K, Pilon D. Understanding the Health System Conditions Affecting the Use of Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia in Clinical Practice: A US Healthcare Provider Survey. Neuropsychiatr Dis Treat 2022; 18:1479-1493. [PMID: 35910684 PMCID: PMC9326898 DOI: 10.2147/ndt.s369494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe factors that enable the routine use of long-acting injectable antipsychotics (LAIs) for appropriate patients in the current clinical practice, including changes in LAI prescribing due to the COVID-19 pandemic and expectations for prescribing in 2021 in the United States (US). METHODS Frequent LAI prescribers recruited from a nationwide panel in 2020 completed an online survey regarding practice characteristics, perspectives on healthcare system conditions enabling routine use of LAIs, and prescribing patterns and changes in patterns during the COVID-19 pandemic. RESULTS Of 408 prescribers who completed the survey, 77.7% were physicians and 59.1% had ≥10 years of psychiatry practice. More than half of frequent prescribers (57.1%) reported treating >20% of their patients with schizophrenia with LAIs. The American Psychiatric Association (APA) guideline was followed by 64.0% of prescribers. Most prescribers identified poor adherence to antipsychotics as a circumstance when LAIs are recommended (94.9%) and patient/caregiver involvement in treatment decisions as a key factor impacting the decision to prescribe LAIs (97.3%). Most prescribers reported that LAI prescribing rates were unchanged in 2020 (59.8%). Similar proportions of prescribers expected no change (44.1%) or an increase (42.9%) in LAI prescribing rates in 2021. The number of patients followed, cost of treatment, and availability of staff to administer LAIs were the main driving factors identified by prescribers expecting an increase in LAI prescribing rates. CONCLUSION LAIs were commonly recommended to patients with poor adherence, and patient/caregiver involvement was an important factor affecting prescribers' treatment decisions. LAI prescribing rates remained unchanged during the COVID-19 pandemic in 2020.
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Affiliation(s)
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Aditi Shah
- Analysis Group, Inc, Montréal, Quebec, Canada
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Shin W, Lee DH, Kim MK, Lee SH, Cho DY, Bang M. Clinical effectiveness of early treatment with paliperidone palmitate in schizophrenia: A retrospective real-world study in South Korea. Early Interv Psychiatry 2021; 15:1759-1767. [PMID: 33445224 DOI: 10.1111/eip.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
AIM Long-acting injectable antipsychotic agents (LAIs) including paliperidone palmitate (PP) have shown promising results in preventing relapse and rehospitalization in schizophrenia. This study aimed to ascertain the comparative real-world effectiveness between the early and late administration of PP and oral formulations of risperidone and paliperidone (ORPs) in patients experiencing a first episode or relapse of schizophrenia. METHODS We identified patients with schizophrenia admitted to a psychiatric ward at least once and treated with ORPs or PP using the Korea National Insurance Claims Database. Patients were divided into three groups based on the clinical data: (1) patients treated with PP within 30 days of the initiation of treatment (early-PP), (2) patients treated with PP after 30 days of the initiation of therapy (late-PP) and (3) patients treated with only ORPs and not received PP (only-ORP). The primary outcomes were determined as psychiatric rehospitalization during the entire duration of treatment after the first discharge. RESULTS A total of 3790 patients (1096 early-PP, 799 late-PP and 1895 only-ORP) were finally included in the analysis. The mean of number and total length of rehospitalization stays during the entire duration in early-PP group were significantly lower than those of late-PP group and only-ORP group (number: 2.32 stays/year, 3.24 stays/year and 4.23 stays/year, p < .001; total length: 50.34 days/year, 72.26 days/year and 105.14 days/year, p < .001). CONCLUSIONS Early treatment with PP was associated with a greater reduction in psychiatric rehospitalization during the treatment period than late treatment with PP and ORP in schizophrenia.
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Affiliation(s)
- Wonsuk Shin
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Dong Hyeon Lee
- Department of Physiology, CHA University School of Medicine, Seongnam, South Korea
| | - Min-Kyoung Kim
- Department of Psychiatry, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, South Korea
| | - Sang-Hyuk Lee
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.,Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Doo-Yeoun Cho
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Wang Y, Wang X, Harlin M, Larsen F, Panni M, Yildirim M, Madera J, Arias L, Forbes A, Mustafa N, Ruiz-White I, Raoufinia A. An alternative start regimen with aripiprazole once-monthly in patients with schizophrenia: population pharmacokinetic analysis of a single-day, two-injection start with gluteal and/or deltoid intramuscular injection. Curr Med Res Opin 2021; 37:1961-1972. [PMID: 34407720 DOI: 10.1080/03007995.2021.1965974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The single-injection start regimen for aripiprazole once-monthly 400 mg (AOM 400) in patients with schizophrenia requires a single intramuscular injection in the gluteal or deltoid site and 14 days of concurrent oral therapy. A simplified, single-day regimen of two injections at separate gluteal and/or deltoid injection sites, together with a single 20-mg dose of oral aripiprazole on the 1st day, was assessed. PATIENTS AND METHODS A previously developed population-pharmacokinetic (popPK) model for characterizing aripiprazole PK following oral administration and gluteal intramuscular depot injection was expanded to include deltoid injection. Simulations were conducted to assess PK profiles following various (including two-injection) start regimens. Postmarketing data on patients who received higher-than-recommended AOM doses were used to assess overall safety/tolerability. RESULTS The two-injection start regimen with a single concurrent oral dose displayed a comparable PK profile to the single-injection start regimen with concurrent 14-day oral administration in simulations. The safety assessment indicated the two-injection start regimen was unlikely to be associated with safety concerns beyond those expected with a single-injection start regimen. CONCLUSION These data support use of the two-injection start regimen in clinical practice to reduce reliance on daily oral administration and optimize the therapeutic benefits of AOM 400 in patients with schizophrenia.
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Affiliation(s)
- Yanlin Wang
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Xiaofeng Wang
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Matt Harlin
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | - Moeen Panni
- Otsuka Pharmaceutical Europe Ltd, Wexham, UK
| | | | - Jessica Madera
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | - Andy Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Nihal Mustafa
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Inez Ruiz-White
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Arash Raoufinia
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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Shymko G, Grace T, Jolly N, Dobson L, Hacking D, Parmar A, Kapi P, Waters F. Weight gain and metabolic screening in young people with early psychosis on long acting injectable antipsychotic medication (aripiprazole vs paliperidone). Early Interv Psychiatry 2021; 15:787-793. [PMID: 32715655 DOI: 10.1111/eip.13013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/07/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
Abstract
AIM Long-acting injectable (LAI)antipsychotics are often used in psychosis to assist with medication compliance and relapse prevention, although the weight gain and metabolic effects in young people are yet to be examined. This study examined the long-term effects of aripiprazole and paliperidone in LAI formulation on weight gain and metabolic parameters in young people with early episode psychosis. METHODS Weight gain and other metabolic effects of aripiprazole and paliperidone in LAI formulation were examined in 59 young people with early episode psychosis over a 12-month period. Changes in outcome measurements were examined at baseline and 3 monthly intervals. RESULTS The results showed that both aripiprazole and paliperidone were associated with time-dependent increases in weight. At 12 months, weight increased by an average of 7% (6 kg) with both aripiprazole and paliperidone relative to the baseline, and the percentage of overweight or obese people increased from 33% to 60%. There was no advantage of aripiprazole compared to paliperidone with regards to weight change, although aripiprazole was associated with lower triglycerides and prolactin levels. CONCLUSIONS Both LAI medications were associated with substantial weight increases over time. These results build on emerging evidence showing that aripiprazole is not weight neutral in young people. Our recommendation is that weight-management programs should be offered from the start of medication initiation.
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Affiliation(s)
- Gordon Shymko
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, Australia
| | - Terina Grace
- Black Swan Health, Perth, Western Australia, Australia
| | - Nicole Jolly
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Louise Dobson
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Daniel Hacking
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Arti Parmar
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, Australia
| | - Puanna Kapi
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Flavie Waters
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,Clinical Research Centre, North Metropolitan Health Service Mental Health, Graylands Hospital, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia
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Cassidy C, Miles W. New Zealand community mental healthcare provider experience in schizophrenia management with 3-monthly paliperidone palmitate. Australas Psychiatry 2021; 29:299-304. [PMID: 32586110 PMCID: PMC8170367 DOI: 10.1177/1039856220928867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To understand the impact of 3-monthly treatment with paliperidone palmitate on patient management, including non-adherence and relapse, from a psychiatrist and nurse perspective for 73 patients enrolled in a patient familiarisation programme (PFP) in New Zealand. METHODS An online questionnaire was sent to clinicians with at least 6 months of regular interaction with PFP patients. Questions addressed treatment effectiveness and patient management changes. Analyses are descriptive only and do not represent patient or carer perspectives. RESULTS Seven psychiatrists, representing 58 of 73 (79.5%) of patients, and 17 nurses responded to the survey. Psychiatrists were satisfied with efficacy and tolerability and relapse prevention. Treatment goals were either 'met' (2/7; 28.6%) or 'exceeded' (5/7; 71.4%). The focus on adherence issues decreased and the focus on life areas and recovery goals increased. CONCLUSIONS From the clinician perspective, 3-monthly paliperidone palmitate offers patients the potential to remain adherent and improve social functioning.
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Affiliation(s)
| | - Wayne Miles
- Waitemata District Health Board Research and Knowledge Centre, New Zealand; and Department of Psychological Medicine, University of Auckland, New Zealand
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10
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Misawa F, Okumura Y, Takeuchi Y, Fujii Y, Takeuchi H. Neuroleptic malignant syndrome associated with long-acting injectable versus oral second-generation antipsychotics: Analyses based on a spontaneous reporting system database in Japan. Schizophr Res 2021; 231:42-46. [PMID: 33752105 DOI: 10.1016/j.schres.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
Long-acting injectable antipsychotics (LAI-APs) remain underutilized. One reason is the concern that LAI-APs might cause serious adverse events such as neuroleptic malignant syndrome (NMS) and lead to prolonged symptoms compared with oral treatment. Because the risk of NMS associated with LAI second-generation antipsychotics (LAI-SGAs) remains unclear, we compared reporting frequency, time to onset, and mortality of NMS between LAI- and oral SGAs using data from a Japanese spontaneous adverse event reporting database between April 2004 and September 2019. Of 5791 patients reporting adverse events due to LAI-SGAs or the equivalent oral SGAs, 768 (13%) developed NMS. LAI aripiprazole and LAI paliperidone were associated with a significantly lower reporting frequency of NMS than the equivalent oral SGAs (adjusted reporting odds ratio [95% confidence interval]: 0.35 [0.19-0.63] and 0.40 [0.27-0.59], respectively). Between 42% and 62% of the NMS associated with LAI- and oral SGAs other than LAI risperidone occurred within 30 days after initiation. The proportion of mortality due to NMS associated with oral aripiprazole was 13.1% and no deaths occurred in patients with NMS associated with LAI aripiprazole. The proportions of mortality due to NMS associated with oral risperidone/paliperidone, LAI risperidone, and LAI paliperidone were 8.8%, 4.2%, and 3.4%, respectively. Our findings showed that LAI-SGAs were not associated with a higher reporting frequency and mortality of NMS compared with oral SGAs, although clinicians need to closely monitor the occurrence of NMS not only during oral SGA treatment, but also, and in particular, in the early stage of LAI-SGA treatment.
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Affiliation(s)
- Fuminari Misawa
- Yamanashi Prefectural Kita Hospital, 3314-13 Kamijouminamiwari, Nirasaki, Yamanashi 407-0046, Japan.
| | - Yasuyuki Okumura
- Initiative for Clinical Epidemiological Research, 1-2-5 Nakamachi, Machida, Tokyo 194-0021, Japan
| | - Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yasuo Fujii
- Yamanashi Prefectural Kita Hospital, 3314-13 Kamijouminamiwari, Nirasaki, Yamanashi 407-0046, Japan
| | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, 3314-13 Kamijouminamiwari, Nirasaki, Yamanashi 407-0046, Japan; Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan; Schizophrenia Division, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
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11
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Can a 4-Month Tolerability Assessment With Paliperidone Palmitate 1-Monthly Prevent Neuroleptic Malignant Syndrome Associated With the 3-Monthly?: Analysis Based on a Spontaneous Reporting System Database in Japan. J Clin Psychopharmacol 2021; 41:206-207. [PMID: 33538535 DOI: 10.1097/jcp.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Successful Introduction of Paliperidone Palmitate for Pregnant Woman With Schizophrenia: Case Presentation and Literature Review. J Clin Psychopharmacol 2021; 41:210-212. [PMID: 33666403 DOI: 10.1097/jcp.0000000000001338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluation of Prescribing Patterns of Long-Acting Injectable Antipsychotics Within a Community Health System. J Clin Psychopharmacol 2020; 39:494-498. [PMID: 31425464 DOI: 10.1097/jcp.0000000000001095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Long-acting injectable antipsychotics (LAIAs) are used in the management of schizophrenia, bipolar disorder, and related psychiatric conditions. The efficacy of LAIAs has been established in randomized controlled trials; however, usage of LAIAs outside of randomized controlled trials may not correlate to naturalistic prescribing habits. The purpose of this analysis was to evaluate the prescribing patterns of LAIAs within our health system and identify any inconsistencies between medications' published labeling information and clinical practice. METHODS/PROCEDURES All patients who received a LAIA at the time of the analysis were included for review. Areas of inconsistency between the prescribed LAIA and each medication's published labeling information were targeted and assessed. Frequency statistics were used to review the following areas for inconsistencies: indication, trial of oral therapy, dose, frequency, and titration method. FINDINGS/RESULTS This analysis included 427 patient cases who received a combined 1480 injections during the analysis period. Overall consistency rates between labeling information and prescribed LAIAs within the analysis period were as follows: 71.2% for indication, 67.4% for trial of oral therapy, 94.4% for dose of LAIA, 84.5% for injection frequency, and 93.9% for titration method. IMPLICATIONS/CONCLUSIONS Inconsistencies were observed between labeling information and clinical practice for LAIAs prescribed within the community health system. Patients who are more symptomatic and have additional psychological comorbidities are commonly excluded from clinical trials. Alternative dosing may be clinically necessary to obtain an adequate response, and this may have been captured in this review. This analysis may be hypothesis generating for future studies on LAIAs.
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Kim HO, Seo GH, Lee BC. Real-world effectiveness of long-acting injections for reducing recurrent hospitalizations in patients with schizophrenia. Ann Gen Psychiatry 2020; 19:1. [PMID: 31956334 PMCID: PMC6958777 DOI: 10.1186/s12991-019-0254-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The comparative effectiveness of antipsychotic long-acting injections (LAIs) and oral medication is not clear due to various methodological problems. METHODS To compare the effectiveness of LAIs and oral antipsychotics in preventing readmission in patients with schizophrenia, we performed a within-subject analysis of data collected from 75,274 patients hospitalized with schizophrenia over a 10-year period (2008-2017). Readmission rates were compared according to medication status (non-medication, oral medication alone, and LAI medication). Each admission episodes were compared according to medication status before admission. RESULTS Total 132,028 episodes of admission were analyzed. During 255,664 person-years of total observation, 101,589 outcome events occurred. Comparing LAI to only oral medication, IRR was 0.71 (0.64-0.78, P < 0.001). IRR of LAI to only oral medication of first index admission was 0.74 (0.65-0.86). As hospitalization was repeated, IRR of second, third, and fourth or more index admission decreased 0.65 (0.53-0.79), 0.56 (0.43-0.76), and 0.42 (0.31-0.56), respectively. CONCLUSIONS LAI treatment reduced the readmission rate by 29% compared with oral medication in real-world settings. Moreover, LAIs reduced the readmission rate by 58% in patients with repeated admissions. The more readmissions, the greater the effect of LAIs in reducing the risk of re-hospitalization compared with oral antipsychotics.
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Affiliation(s)
- Hye Ok Kim
- 1Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Gi Hyeon Seo
- 1Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Boung Chul Lee
- 1Health Insurance Review and Assessment Service, Seoul, South Korea.,2Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, 07247 Seoul, South Korea
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Barbui C, Bertolini F, Bartoli F, Calandra C, Callegari C, Carrà G, D'Agostino A, Lucii C, Martinotti G, Mastromo D, Moretti D, Monzani E, Porcellana M, Prestia D, Ostuzzi G. Reasons for initiating long-acting antipsychotics in psychiatric practice: findings from the STAR Network Depot Study. Ther Adv Psychopharmacol 2020; 10:2045125320978102. [PMID: 33489087 PMCID: PMC7768845 DOI: 10.1177/2045125320978102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Long acting injectable (LAI) antipsychotics have been claimed to ensure treatment adherence and possibly reduce the daily burden of oral formulations. So far, only surveys investigating the theoretical prescribing attitudes of clinicians have been employed. On this basis, we aimed to investigate reasons for prescribing LAIs in a real-world, unselected sample of patients. METHODS The STAR Network Depot Study is an observational, multicentre study consecutively enrolling adults initiating a LAI over a 12-months period. Clinical severity was assessed with the Brief Psychiatric Rating Scale, and patient's attitude toward medications with the Drug Attitude Inventory 10 items. Psychiatrists recorded reasons for LAI prescribing for each study participant. Responses were grouped into six non-mutually exclusive categories: aggressiveness, patient engagement, ease of drug taking, side-effects, stigma, adherence. RESULTS Of the 451 patients included, two-thirds suffered from chronic psychoses. Improving patient engagement with the outpatient psychiatric service was the most common reason for prescribing LAIs (almost 80% of participants), followed by increasing treatment adherence (57%), decreasing aggressiveness (54%), and improving ease of drug taking (52%). After adjusting for confounders, logistic regression analyses showed that reasons for LAI use were associated with LAI choice (e.g. first-generation LAIs for reducing aggressiveness). CONCLUSION Despite the wide availability of novel LAI formulation and the emphasis on their wider use, our data suggest that the main reasons for LAI use have remained substantially unchanged over the years, focusing mostly on improving patient's engagement. Further, clinicians follow implicit prescribing patterns when choosing LAIs, and this may generate hypotheses for future experimental studies.
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Affiliation(s)
- Corrado Barbui
- WHO 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
| | - Federico Bertolini
- WHO 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
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Carmela Calandra
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria-ASST Sette Laghi, Varese, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Claudio Lucii
- UOC Psichiatria Siena, Azienda USL Toscana Sudest, Siena, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University 'G. d'Annunzio', Chieti, Italy
| | - Daniele Mastromo
- Dipartimento Salute Mentale e Dipendenze, ASST Grande Ospedale Metropolitano Niguarda Milano, Milano, Italy
| | - Daniele Moretti
- ASL2 Regione Liguria, Centro di Salute Mentale di Finale Ligure, Savona, Italy
| | - Emiliano Monzani
- Dipartimento Salute Mentale e delle Dipendenze, ASST Bergamo Ovest, Treviglio (Bergamo), Italy
| | - Matteo Porcellana
- Dipartimento Salute Mentale e Dipendenze, ASST Grande Ospedale Metropolitano Niguarda Milano, Milano, Italy
| | - Davide Prestia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
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16
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Blackwood C, Sanga P, Nuamah I, Keenan A, Singh A, Mathews M, Gopal S. Patients' Preference for Long-Acting Injectable versus Oral Antipsychotics in Schizophrenia: Results from the Patient-Reported Medication Preference Questionnaire. Patient Prefer Adherence 2020; 14:1093-1102. [PMID: 32753849 PMCID: PMC7342487 DOI: 10.2147/ppa.s251812] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Understanding patients' preferences for long-acting injectable (LAI) or oral antipsychotics (pills) could help reduce potential barriers to LAI use in schizophrenia. METHODS Post hoc analyses were conducted from a double-blind, randomized, non-inferiority study (NCT01515423) of 3-monthly vs 1-monthly paliperidone palmitate in patients with schizophrenia. Data from the Medication Preference Questionnaire, administered on day 1 (baseline; open-label stabilization phase), were analyzed. The questionnaire includes four sets of items: 1) reasons for general treatment preference based on goals/outcomes and preference for LAI vs pills based on 2) personal experience, 3) injection-site (deltoid vs gluteal), 4) dosing frequency (3-monthly vs 1-monthly). A logistic regression analysis was performed to assess the effect of baseline variables on preference (LAIs or pills). RESULTS Data from 1402 patients were available for analysis. Patients who preferred LAIs recognized these outcomes as important: "I feel more healthy" (57%), "I can get back to my favorite activities" (56%), "I don't have to think about taking my medicines" (54%). Most common reasons for medication preference (LAI vs pills) were: "LAIs/pills are easier for me" (67% vs 18%), "more in control/don't have to think about taking medicine" (64% vs 14%), "less pain/sudden symptoms" (38% vs 18%) and "less embarrassed" (0% vs 46%). Majority of patients (59%) preferred deltoid over gluteal injections (reasons: faster administration [63%], easier [51%], less embarrassing [44%]). In total, 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing citing reasons: fewer injections [96%], fewer injections are less painful [84%], and fewer doctor visits [80%]. From logistic regression analysis, 77% of patients preferred LAI over pills; culture and race appeared to play a role in this preference. CONCLUSION Patients who preferred LAI antipsychotics prioritized self-empowerment and quality-of-life-related goals. When given the option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.
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Affiliation(s)
| | - Panna Sanga
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Isaac Nuamah
- Clinical Biostatistics, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Alexander Keenan
- Health Economics and Market Access, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Arun Singh
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Srihari Gopal
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
- Correspondence: Srihari Gopal Email
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Retief M, Chiliza B, Phahladira L, Emsley R, Asmal L. Prolactin, flupenthixol decanoate and first episode schizophrenia - clinical and laboratory correlates. Metab Brain Dis 2019; 34:1679-1687. [PMID: 31422510 DOI: 10.1007/s11011-019-00474-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/28/2019] [Indexed: 01/03/2023]
Abstract
First-episode psychosis (FEP) patients are more sensitive to neuroleptic side-effects such as hyperprolactinemia. We examined the prolactin levels of previously minimally treated patients with first episode schizophrenia over their first year of treatment with flupenthixol decanoate and the relationship between prolactin levels, gender and clinical features of schizophrenia. Prolactin levels were assessed at three monthly intervals in 126 patients with first-episode schizophrenia in a single-site study conducted over 12 months during treatment with flupenthixol decanoate according to a fixed protocol. The mean prolactin level for the total sample was 11.91 ng/ml (standard deviation [SD]15.52) at baseline. Women had higher levels of prolactin than men at month 3, 6 and 12, reaching statistical significance at month 12 (p = 0.02). At 12 months more women than men had hyperprolactinemia (defined as more than 20 ng/ml for males, and as more than 25 ng/ml for females (p = 0.007). Using a mixed effect model, there was a significant association between prolactin change scores over 12 months and gender (p = 0.025) as well as Positive and Negative Syndrome Scale (PANSS) total scores (p = 0.001). In addition female gender (p = 0.04) and age (p = 0.02) correlated with the risk of hyperprolactinemia as categorical variable. In this study treatment with flupenthixol decanoate was associated with relatively low levels of hyperprolactinemia, likely owing to flupenthixol's relatively atypical mode of action, as well as to the low doses used in our study. We found an inverse correlation between total PANSS scores and prolactin levels, which could support the suggested theory of prolactin having antipsychotic properties. Our study confirms the importance of gender on the prolactin raising effects of antipsychotic treatment.
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Affiliation(s)
- Mari Retief
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lebogang Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
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Wesołowska A, Jastrzębska-Więsek M, Cios A, Partyka A. The preclinical discovery and development of paliperidone for the treatment of schizophrenia. Expert Opin Drug Discov 2019; 15:279-292. [DOI: 10.1080/17460441.2020.1682994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Anna Wesołowska
- Jagiellonian University Medical College, Department of Clinical Pharmacy, Kraków, Poland
| | | | - Agnieszka Cios
- Jagiellonian University Medical College, Department of Clinical Pharmacy, Kraków, Poland
| | - Anna Partyka
- Jagiellonian University Medical College, Department of Clinical Pharmacy, Kraków, Poland
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Use of Long-Acting Injectable Antipsychotic in an Inpatient Unit of a Community Teaching Hospital. PSYCHIATRY JOURNAL 2019; 2019:8629030. [PMID: 31312652 PMCID: PMC6595334 DOI: 10.1155/2019/8629030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022]
Abstract
Background Individuals with Schizophrenia Spectrum Disorders (SSD) often experience significant impairment in educational, occupational, and psychosocial functioning. The clinical benefit of long-acting injectable antipsychotics (LAIs) in the management of patients with SSD is well established. SSD patients who are nonadherent to treatment have lower disease relapse and readmission rates when prescribed a LAI, compared to oral antipsychotics. Despite the reported advantages of LAIs, their prescription rates in clinical settings remain low. This pilot study aimed to determine the pattern of LAI prescription in psychiatric inpatients of a teaching community hospital in Brooklyn, New York. Methods A retrospective review of the charts of patients discharged from the psychiatric units of the hospital from September 1, 2017, through September 30, 2017, was conducted. Frequencies and proportions for demographic and disease-related characteristics were calculated. Pertinent continuous variables were recoded into categorical variables. Chi-square-tests or Fisher's exact tests were performed for categorical variables. The one-sample Shapiro-Wilk test (for sample size < 50) was used to check for the normality of distribution of continuous variables. Statistical significance was defined as p ≤ 0.05. Results Forty-three (70%) of the patients discharged from the inpatient unit during the study period had SSD and were eligible for a LAI. Their ages ranged from 20 to 71 years (mean = 41 years), and more than two-thirds were male. Less than half of the eligible patients (n = 19; 44%) were prescribed a LAI, most of whom were male (n=16; 84%). An association between age group (patients aged 41 years or younger) and LAI use was observed (p < 0.05), while gender, employment status, living arrangement, length of hospital stay, recent hospitalization, and cooccurring substance use disorder were not. Conclusion LAI prescription rate at the inpatient psychiatric unit of the hospital was marginally higher than those reported in most studies. Age appears to influence LAI use during the study period. Initiatives that increase LAI prescription rate for all eligible patients admitted to inpatient psychiatric unit should be encouraged.
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20
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Wu Z, Zhao M, Zhang W, Yang Z, Xu S, Shang Q. Influence of drying processes on the structures, morphology and in vitro release profiles of risperidone-loaded PLGA microspheres. J Microencapsul 2019; 36:21-31. [PMID: 30757946 DOI: 10.1080/02652048.2019.1582723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to investigate the influences of drying methods on the risperidone (RIS) release profiles of RIS-loaded PLGA microspheres. These microspheres were fabricated with an O/W emulsion solvent evaporation method. The wet microspheres were dried with freeze drying and vacuum drying methods. The microspheres were mono-dispersed spheres with an average diameter of 100 μm. Studies found that drying methods had great influence on the porosity, morphology, and release profiles of RIS-loaded PLGA microspheres. Specifically, the freeze-dried microspheres had higher porosity (78.46 ± 1.64%) than those vacuum-dried ones (52.45 ± 2.68%), and they showed higher RIS release rates (p < 0.05). In the accelerated release tests (45 °C), these microspheres dried under the pressures of 700 mmHg and 200 mmHg gave faster release rates than those ones dried under the pressure of 450 mmHg. Importantly, the accelerated release test (45 °C) had a high correlation with the real-time test (37 °C) (R2 > 0.99). These studies exhibited a significance in the precise preparation of RIS-loaded PLGA microspheres.
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Affiliation(s)
- Zhaoying Wu
- a Chemical and Pharmaceutical Engineering Institute , Hebei University of Science and Technology , Hebei , China
| | - Mengqing Zhao
- a Chemical and Pharmaceutical Engineering Institute , Hebei University of Science and Technology , Hebei , China
| | - Wei Zhang
- a Chemical and Pharmaceutical Engineering Institute , Hebei University of Science and Technology , Hebei , China
| | - Zhao Yang
- a Chemical and Pharmaceutical Engineering Institute , Hebei University of Science and Technology , Hebei , China
| | - Shuxin Xu
- b Tianjin Branch of Suzhou Institute of Biomedical Engineering and Technology, CAS , Tianjin , PR China
| | - Qing Shang
- a Chemical and Pharmaceutical Engineering Institute , Hebei University of Science and Technology , Hebei , China
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Comparison of Paliperidone Palmitate and Second-Generation Oral Antipsychotics in Terms of Medication Adherence, Side Effects, and Quality of Life. J Clin Psychopharmacol 2019; 39:57-62. [PMID: 30566417 DOI: 10.1097/jcp.0000000000000993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although schizophrenia can be treated effectively, acute aggravations and relapses occur often. Antipsychotic drug therapies are fairly effective for decreasing the rate of relapses in patients with schizophrenia. This study aimed to compare paliperidone palmitate and the second-generation oral antipsychotic drugs used to treat patients with schizophrenia in terms of medication adherence, side effects, and quality of life. METHODS The study included 33 patients diagnosed with schizophrenia who were treated with paliperidone palmitate and 51 patients who were treated with second-generation oral antipsychotics. All the patients were administered the Positive and Negative Syndrome Scale, the Clinical Global Impression, the Extrapyramidal Symptom Rating Scale, the UKU (Ugvalg for Kliniske Undersgelser) Side Effect Rating Scale, the Short Form 36, the Morisky Medication Adherence Scale, and the Schedule for Assessing the Three Components of Insight. RESULTS The medication adherence and perceived general health scores of the patients treated with paliperidone palmitate were significantly higher than those of the patients treated with second-generation antipsychotics, and the side effects of the medication on the patients' daily performance were significantly lower. CONCLUSIONS This study demonstrated that long-acting paliperidone palmitate therapy was associated with more favorable results in terms of medication adherence, drug side effects, and quality of life compared with second-generation oral antipsychotics. However, there is a need for further, more specific, and larger-scale studies in this field.
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22
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Si T, Zhuo J, Feng Y, Lu H, Hong D, Zhang L. Long-term efficacy and safety of paliperidone palmitate once-monthly in Chinese patients with recent-onset schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1685-1694. [PMID: 31303756 PMCID: PMC6603286 DOI: 10.2147/ndt.s191803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The subgroup analysis of a primary study (NCT01051531) evaluated the effect of long-term paliperidone palmitate once-monthly (PP1M) therapy in Chinese patients with recent-onset schizophrenia responding unsatisfactorily to previous oral antipsychotics. Patients and methods: This 18-month, open-label study consisted of 3 phases - screening (7 days), treatment (18 months) and end-of-study/withdrawal visit. All enrolled patients (18-50 years) received PP1M: 150 mg eq. (day 1), 100 mg eq. (day 8) followed by a once-monthly flexible dose (50, 75, 100 or 150 mg eq.). Efficacy and safety were assessed. Results: Among the 118 enrolled Chinese patients, 68 completed the treatment (mean age: 25.6 years; male: 54.7%). A clinically meaningful change from baseline to day 548 was observed in Positive and Negative Syndrome scale (primary endpoint, mean [SD]: -15.3 [20.76]), Personal and Social Performance scale (15.9 [19.65]), Clinician Global Impression-schizophrenia score (-1.2 [1.54]) and Medication Satisfaction Questionnaire score (0.9 [1.73]). Commonly reported treatment-emergent adverse events (TEAEs) included insomnia (13.9%), injection-site pain (13.9%), upper respiratory tract infection (13.0%), restlessness (13.0%) and akathisia (13.0%). Serious TEAEs were reported in 9.3% patients with schizophrenia being most common (6.5%) and one death (suicide) was observed. Conclusion: Efficacy of PP1M corroborate findings from earlier studies and no new safety concerns emerged in this Chinese subgroup of patients with schizophrenia.
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Affiliation(s)
- Tianmei Si
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People's Republic of China.,Peking University Institute of Mental Health/The Sixth Hospital, Beijing, People's Republic of China
| | - Jianmin Zhuo
- Janssen (China) Research & Development Center, Johnson & Johnson (China) Investment Ltd., Shanghai, People's Republic of China
| | - Yu Feng
- Department of Neuroscience, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Huafei Lu
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Di Hong
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Lili Zhang
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
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Pietrini F, Albert U, Ballerini A, Calò P, Maina G, Pinna F, Vaggi M, Boggian I, Fontana M, Moro C, Carpiniello B. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1045-1060. [PMID: 31118640 PMCID: PMC6503342 DOI: 10.2147/ndt.s199048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a chronic syndrome involving different clinical dimensions, and causes significant disability with a negative impact on the quality of life of patients and their caregivers. Current guidelines for the treatment of schizophrenia focus on maximizing a patient's adaptive functioning and quality of life in a recovery-oriented approach that encourages active collaboration among patients, caregivers, and mental health professionals to design and manage a customized and comprehensive care plan. In the present study, a panel of experts (psychiatrists, psychologists, nurse, and social worker) gathered to review and explore the need for contemporary use of second-generation antipsychotic long-acting injectables (SGA LAIs) in "recovery-oriented" and "patient-centered" care of schizophrenia. Starting from the available data and from sharing personal attitudes and experiences, the panel selected three clinical dimensions considered useful in characterizing each patient: phase of disease, adherence to treatment, and level of functioning. For each clinical dimension, perspectives of patients and caregivers with regard to needs, expectations, and personal experiences were reviewed and the role of SGA LAIs in achieving shared goals examined. The experts concluded that from today's modern perspectives, SGA-LAIs may play an important role in breaking the spiral of desocialization and functional decline in schizophrenia, thus favoring the recovery process.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Marco Vaggi
- Department of Mental Health and Drug Addiction ASL 3 Genoa, Azienda Sanitaria 3 Genovese, Genoa, Italy
| | - Ileana Boggian
- Department of Mental Health, Azienda Ulss 9 Scaligera, Legnago, Italy
| | - Maria Fontana
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Cesare Moro
- Department of Mental Health and Addictions, ASST Bergamo Ovest, Treviglio, Italy
| | - Bernardo Carpiniello
- Psychiatric Clinical Unit, University Hospital of Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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Madera JJ, Such P, Zhao C, Baker RA. Symptomatic stability with aripiprazole once-monthly: efficacy analyses from acute and long-term studies. Neuropsychiatr Dis Treat 2019; 15:1593-1604. [PMID: 31354275 PMCID: PMC6590622 DOI: 10.2147/ndt.s198786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/09/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the effect of aripiprazole once-monthly 400 mg (AOM 400; Abilify Maintena®) on symptom stability in acute treatment and maintenance therapy settings in patients with schizophrenia. Methods: Results were analyzed from two pivotal maintenance studies (Studies 246 and 247), a long-term (52 weeks), open-label extension of these studies (Study 248), an open-label, mirror-image study in patients switching from oral to long-acting injectable antipsychotic therapy (Study 283), and a study of AOM 400 in the acute setting (Study 291). Symptom stability was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) scale (CGI-Severity of Illness and CGI-Improvement). Results are reported for the total study population and in subgroups stratified by age. Results: In Study 246, AOM 400 resulted in significantly greater improvements from baseline vs placebo on all measures of symptom stability, with improvements maintained through 52 weeks. In Study 247, a non-inferiority study, AOM 400 resulted in improvements in PANSS and CGI scores comparable or significantly greater at all timepoints vs oral aripiprazole. In Study 248, AOM 400 resulted in the long-term stability of symptom improvements from the earlier studies. In Study 283, AOM 400 resulted in significant improvements from baseline in PANSS and CGI scores over 24 weeks. In Study 291, AOM 400 resulted in significantly greater improvements from baseline in PANSS and CGI scores vs placebo at all post-baseline timepoints. In post hoc analyses, AOM 400 showed similar efficacy in symptom improvement in adult patients aged ≤35 years and >35 years, with some evidence of a larger treatment effect on PANSS negative symptoms among younger patients in the acute treatment setting. Conclusion: In acute treatment and maintenance therapy settings, AOM 400 was effective in the rapid stabilization and long-term maintenance of symptoms in patients with schizophrenia.
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Affiliation(s)
- Jessica J Madera
- Global Medical Affairs , Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Pedro Such
- Medical Affairs Psychiatry, H. Lundbeck A/S, Valby, Denmark
| | - Cathy Zhao
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Ross A Baker
- Global Medical Affairs , Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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Attitudes Concerning Antipsychotic Depot Medication in the German General Population: A Representative Telephone Survey. J Clin Psychopharmacol 2018; 38:612-617. [PMID: 30334865 DOI: 10.1097/jcp.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Treatment of schizophrenia with depot medication has advantages compared with oral medication, and among these include an improved compliance. Despite such advantages, prescription rates in many European countries are lower than 20%. The aim of this survey was to study the attitudes toward depot medication among the German general population. To the best of our knowledge, only selective samples have been investigated up until now. METHODS A representative sample of 754 people were interviewed via telephone by a professional market research and polling organization. The questionnaire queried demographic characteristics, experience with medication, and the treatment of mental disorders. Subjects' attitudes toward medication in general, long-term medication, and depot medication were surveyed. RESULTS Most (66.7%) of the subjects stated that they would be willing to receive depot medication. Subjects who experienced the treatment of mental disorders were more likely to be willing to receive depot medication. Among the reasons for not using depot medication, "fear of injection" (66.3%) and "more self-control when taking medication as tablets" (48.9%) were stated as the most frequent reasons. CONCLUSIONS This study found a good acceptance of antipsychotic depot medication among the German general population in terms of willingness to receive such treatment. We argue that the clinical practitioners' assumptions that depot formulations would be refused by many patients are unsubstantiated.
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Mathews M, Pei H, Savitz A, Nuamah I, Hough D, Alphs L, Gopal S. Paliperidone Palmitate 3-Monthly Versus 1-Monthly Injectable in Patients With Schizophrenia With or Without Prior Exposure to Oral Risperidone or Paliperidone: A Post Hoc, Subgroup Analysis. Clin Drug Investig 2018; 38:695-702. [PMID: 29882073 DOI: 10.1007/s40261-018-0647-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Paliperidone palmitate 3-monthly (PP3M) injectable formulation offers an advantage of improved medication adherence and lower relapse risk in patients with schizophrenia. This post hoc analysis compared outcomes following PP3M versus paliperidone palmitate 1-monthly (PP1M) treatment in patients with schizophrenia treated/untreated with oral risperidone/paliperidone (RIS/PALI). METHODS Patients were treated with PP1M (50, 75, 100, or 150 mg equivalent [eq.]) for 17 weeks during an open-label (OL) phase and randomized (1:1) to PP3M (175, 263, 350, or 525 mg eq.) or PP1M (50, 75, 100, or 150 mg eq.) during a 48-week double-blind phase. Efficacy outcomes were compared based on prior oral RIS/PALI exposure: recent (≥ 28 days of oral RIS/PALI exposure with last dose within 14 days before study entry); or no (no oral RIS/PALI exposure within 60 days before study entry). RESULTS A total of 452 OL patients received recent oral RIS/PALI (n = 323 [71%], randomized to PP3M = 166; PP1M = 157), and 709 OL patients were without recent oral RIS/PALI (n = 506 [71%], randomized to PP3M = 254; PP1M = 252). Improvements in Positive and Negative Syndrome Scale (PANSS) scores (OL baseline-to-endpoint) were similar in recent-RIS/PALI (mean [standard deviation]:18.3 [17.96]) and no-RIS/PALI (- 21.1 [16.40]) subgroups. Relapse-free rates were comparable between recent-RIS/PALI (relapse-free rate [95% confidence interval for difference]: 2.6 [- 4.7 to 10.0]; PP3M: 90%; PP1M: 87%) and no-RIS/PALI subgroups (0.8 [- 4.5 to 6.0]; PP3M: 92%; PP1M: 91%). Weight gain was the most common (> 5% incidence) treatment-emergent adverse event in both subgroups irrespective of the prior treatment. CONCLUSION Patients with schizophrenia, irrespective of prior treatment with RIS/PALI, had comparable treatment outcomes and tolerability following PP3M or PP1M treatment. REGISTRATION This study is registered at the EU clinical trial registry (EudraCT Number: 2011-004889-15) and ClinicalTrials.gov (identifier: NCT01515423).
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Affiliation(s)
- Maju Mathews
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Huiling Pei
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Adam Savitz
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Isaac Nuamah
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - David Hough
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Larry Alphs
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Srihari Gopal
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Suda A, Hattori S, Kishida I, Miyauchi M, Shiraishi Y, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Moritani T, Hirayasu Y. Effects of long-acting injectable antipsychotics versus oral antipsychotics on autonomic nervous system activity in schizophrenic patients. Neuropsychiatr Dis Treat 2018; 14:2361-2366. [PMID: 30271152 PMCID: PMC6149934 DOI: 10.2147/ndt.s173617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Long-acting injections (LAIs) of antipsychotics show distinct pharmacokinetic profiles from oral antipsychotics (OAPs). Although there may be differences in adverse event frequency, any differences in their effects on autonomic nervous system (ANS) remain unclear. PATIENTS AND METHODS In total, 270 schizophrenic patients were recruited in this study: 241 received OAPs (risperidone, olanzapine, quetiapine, or aripiprazole) and 29 received LAIs (risperidone LAI, aripiprazole LAI, or paliperidone palmitate) as monotherapy. Heart rate variability was measured as an index of ANS activity, and the low-frequency (0.03-0.15 Hz) component, high-frequency (0.15-0.40 Hz) component, and total power (0.03-0.40 Hz) were calculated. Components were compared between the groups using t-tests. RESULTS A significant difference was detected in the low-frequency component between the OAP and LAI groups (P=0.046). No significant difference was found in total power or the high-frequency component between the two groups. CONCLUSION Compared with OAPs, LAIs have fewer adverse effects on ANS activity, particularly the low-frequency component, as determined using a spectral analysis of heart rate variability.
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Affiliation(s)
- Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, Osaka
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University
| | - Chie Ishii
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Norio Ishii
- Department of Psychiatry, Fujisawa Hospital, Kanagawa
| | - Toshio Moritani
- Department of Health and Sports Sociology, Faculty of General Education, Kyoto Sangyo University, Kyoto
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama,
- Department of Psychiatry, Hirayasu Hospital, Okinawa, Japan
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Parellada E, Bioque M, Serrano M, Herrera B, García Dorado M. An open-treatment six-week study of the clinical effectiveness of Paliperidone Palmitate in schizophrenia: data from acute units in Spain (SHADOW study). Int J Psychiatry Clin Pract 2018; 22:191-199. [PMID: 29161951 DOI: 10.1080/13651501.2017.1404112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate clinical evolution of patients with schizophrenia admitted in acute units because of a relapse and treated with once-monthly Paliperidone Palmitate (PP1M). METHODS This multicentre, open-label, prospective observational study followed patients with schizophrenia treated with PP1M in acute psychiatric units for up to 6 weeks. RESULTS Out of the 280 enrolled patients, 61 received PP1M as antipsychotic monotherapy, and 219 in combination with other antipsychotics. The average Clinical Global Impression-Schizophrenia (CGI-SCH) score decreased from 4.7 at baseline to 3.3 at final visit (p < .0001); the change was clinically and statistically significant both in patients treated with PP1M in monotherapy and in combination with other antipsychotics. Clear improvements in functioning and high patient satisfaction with the treatment were observed. Time from admission to PP1M therapy initiation correlated with the length of hospital stay (p < .0001); earlier start of PP1M treatment was associated with shorter hospital stay. Adverse events were reported in 7.1% of patients (all non-serious). CONCLUSIONS PP1M was effective and well tolerated in treatment of acute episodes of schizophrenia both in monotherapy and in combination with other antipsychotics in clinical setting. Early start of PP1M therapy in acute schizophrenia episodes might help to shorten hospital stay.
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Affiliation(s)
- Eduard Parellada
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Miquel Bioque
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | | | - Berta Herrera
- c Medical Affairs Department , Janssen-Cilag, S.A , Madrid , Spain
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Sajatovic M, Ross R, Legacy SN, Correll CU, Kane JM, DiBiasi F, Fitzgerald H, Byerly M. Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics - expert consensus survey part 1. Neuropsychiatr Dis Treat 2018; 14:1463-1474. [PMID: 29922062 PMCID: PMC5997124 DOI: 10.2147/ndt.s167394] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use. METHODS A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported. RESULTS Recommendations aligned with research on risk factors for nonadherence and poor outcomes for patients with schizophrenia/schizoaffective or bipolar disorder. Findings suggested, contrary to general practice patterns, that LAI use may be appropriate earlier in the disease course and in younger patients. Results for bipolar disorder were similar to those for schizophrenia but with less consensus. Numerous facilitators of LAI prescribing were considered important, particularly that LAIs may reduce relapses and improve outcomes. CONCLUSION Findings support wider use of LAIs in patients with schizophrenia/schizoaffective and bipolar disorders beyond the setting of poor adherence and earlier use in the disease course.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ruth Ross
- Ross Editorial, Port Townsend, WA, USA
| | - Susan N Legacy
- US Medical Affairs Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Christoph U Correll
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
| | - John M Kane
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
| | - Faith DiBiasi
- Scientific Communications, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | | | - Matthew Byerly
- Cell Biology and Neuroscience, Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, USA
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Sajatovic M, Ross R, Legacy SN, Byerly M, Kane JM, DiBiasi F, Fitzgerald H, Correll CU. Initiating/maintaining long-acting injectable antipsychotics in schizophrenia/schizoaffective or bipolar disorder - expert consensus survey part 2. Neuropsychiatr Dis Treat 2018; 14:1475-1492. [PMID: 29922063 PMCID: PMC5997122 DOI: 10.2147/ndt.s167485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide recommendations on initiating and maintaining long-acting injectable antipsychotics (LAIs) in individuals with schizophrenia/schizoaffective or bipolar disorder. METHODS A 50-question survey comprising 916 response options was completed by 34 expert researchers and high prescribers with extensive LAI experience, rating relative appropriateness/importance on a 9-point scale. Consensus was determined using chi-square test of score distributions. Results of 21 questions comprising 339 response options regarding LAI initiation, maintenance treatment, adequate trial definition, identifying treatment nonresponse, and switching are reported. RESULTS Experts agreed that the most important LAI selection factor was patient response/tolerability to previous antipsychotics. An adequate therapeutic LAI trial was defined as the time to steady state ± 1-2 injection cycles. Experts suggested that oral efficacy and tolerability should be established before switching to an LAI, without consensus on the required time, and that the time for oral supplementation and next injection interval should be determined by the time to attainment of therapeutic LAI levels. Most experts agreed that ≥1 adequate LAI trial is needed to identify the lack of efficacy. There was little agreement about strategies for switching between LAIs. CONCLUSION Expert guidance may aid clinicians in their decisions regarding initiating/maintaining LAIs in individuals with schizophrenia/schizoaffective or bipolar disorder.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ruth Ross
- Ross Editorial, Port Townsend, WA, USA
| | - Susan N Legacy
- US Medical Affairs Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Matthew Byerly
- Cell Biology and Neuroscience, Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, USA
| | - John M Kane
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
| | - Faith DiBiasi
- Scientific Communications, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | | | - Christoph U Correll
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
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Nuhoho S, Saad A, Saumell G, Ribes D, El Khoury AC. Economic evaluation of paliperidone palmitate once monthly for treating chronic schizophrenia patients in the United Arab Emirates. Curr Med Res Opin 2018; 34:601-611. [PMID: 29292670 DOI: 10.1080/03007995.2017.1417246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Schizophrenia is one of the most debilitating diseases in the United Arab Emirates. Oral antipsychotics (OA) are commonly used in terms of pharmacotherapy; however, these treatments can be rendered ineffective by poor patient adherence. Paliperidone palmitate once monthly (PP1M) is a long acting antipsychotic which can offer an adherence advantage when compared to oral treatments. The study objective is to estimate the cost effectiveness of PP1M in the UAE setting. RESEARCH DESIGN AND METHODS A 1-year validated decision-tree model was adapted to the UAE setting using published literature and expert opinion. Patients on PP1M were compared with or without oral supplementation to patients on any oral antipsychotic. Patient outcomes studied were incremental cost per quality adjusted life years gained, incremental cost per hospitalizations, relapses, and emergency room visits averted. RESULTS After 1 year, patients on PP1M monotherapy when compared to oral antipsychotics had better outcomes (0.840 vs 0.811 QALYs; 31 relapse days averted as well as 9 and 24 percentage points of ER and hospitalizations averted, respectively), and better healthcare savings (AED 1405). PP1M economically dominated oral antipsychotics. The results were stable across a broad range of deterministic and probabilistic sensitivity analyses. PP1M plus oral antipsychotics could not be evaluated due to the absence of clinical data that would provide insight into the clinical value of combination therapy. CONCLUSION PP1M is estimated to save the UAE healthcare system money, while at the same time improving patient outcomes.
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Affiliation(s)
- Solomon Nuhoho
- a Johnson & Johnson Middle East FZ LLC , Dubai , United Arab Emirates
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32
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Huang M, Yu L, Pan F, Lu S, Hu S, Hu J, Chen J, Jin P, Qi H, Xu Y. A randomized, 13-week study assessing the efficacy and metabolic effects of paliperidone palmitate injection and olanzapine in first-episode schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:122-130. [PMID: 29097257 DOI: 10.1016/j.pnpbp.2017.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study was conducted to evaluate the efficacy and metabolic effects of paliperidone palmitate (PP) injections against oral olanzapine in first-episode schizophrenia (FES) patients. METHODS Eligible patients were randomized to receive PP or olanzapine. Efficacy assessments and weight-related parameters were assessed at baseline, weeks 1, 5, 9, and endpoint or at early withdrawal. Lipid, glucose, insulin and prolactin were evaluated at baseline and endpoint or at early withdrawal. RESULTS The Positive And Negative Syndrome Scale (PANSS) scores declined significantly after treatment in both groups. Significant increases in weight-related parameters from baseline to endpoint were shown in both groups. Although there was no significant difference in PANSS scores and weight-related parameters between the two groups through the whole 13-week study. The increased level of triglyceride and HOMA-IR at endpoint from baseline in the olanzapine group was higher than the PP group. There was a stronger elevation of prolactin level in the PP group. CONCLUSIONS In summary, PP and olanzapine showed similar improvement in the treatment of FES patients. This study also reinforced the necessity for regular monitoring of metabolic parameters in schizophrenia patients prescribed atypical antipsychotics. Clinical trial registration numbers: ChiCTR-IOR-14005304. Date of registration: 2014-10-11.
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Affiliation(s)
- Manli Huang
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Liang Yu
- Department of Anesthesiology and Pain, Hang Zhou First People's Hospital, No. 261, Huansha Road, Hangzhou 310006, China
| | - Fen Pan
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Shaojia Lu
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Jianbo Hu
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Jinkai Chen
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Pingbo Jin
- College of Medcine, Zhejiang University, No. 268, Kaixuan Road, Hangzhou 310000, China
| | - Hongli Qi
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Yi Xu
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China.
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Calabrese JR, Sanchez R, Jin N, Amatniek J, Cox K, Johnson B, Perry P, Hertel P, Such P, McQuade RD, Nyilas M, Carson WH. Symptoms and functioning with aripiprazole once-monthly injection as maintenance treatment for bipolar I disorder. J Affect Disord 2018; 227:649-656. [PMID: 29174738 DOI: 10.1016/j.jad.2017.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Effects of maintenance treatment with aripiprazole once-monthly 400mg (AOM 400) on symptoms and functioning were assessed in adults with bipolar I disorder (BP-I) after a manic episode. METHODS Patients were stabilized on oral aripiprazole, cross-titrated to AOM 400, then randomized in a 52-week, double-blind, placebo-controlled, withdrawal phase. Prespecified secondary outcomes are reported: time to hospitalization for mood episode, Young Mania Rating Scale (YMRS), Montgomery-Åsberg Depression Rating Scale (MADRS), Clinical Global Impression-Bipolar scale, Functioning Assessment Short Test (FAST), and Brief Quality of Life in Bipolar Disorder questionnaire. Time to hospitalization for mood episode was analyzed using log-rank test and changes from baseline using mixed model for repeated measures or analysis of covariance. RESULTS AOM 400 significantly increased time to hospitalization for any mood episode versus placebo (P=0.0002). YMRS total scores decreased with oral aripiprazole; improvements were maintained with AOM 400. After randomization, YMRS scores changed little with AOM 400 but worsened with placebo (P=0.0016), and MADRS scores, already low at trial initiation, did not differ between groups. FAST score improvements were maintained with AOM 400 but not placebo (P=0.0287). LIMITATIONS Results are generalizable to patients with BP-I stabilized on aripiprazole following a manic episode. CONCLUSIONS Patients with BP-I experiencing an acute manic episode exhibited symptomatic and functional improvements during stabilization with oral aripiprazole and AOM 400 that were maintained with continued AOM 400 treatment but not placebo. AOM 400 is the first once-monthly long-acting injectable antipsychotic to demonstrate efficacy in maintenance treatment of the manic phase of BP-I.
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Affiliation(s)
| | - Raymond Sanchez
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Na Jin
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Joan Amatniek
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Kevin Cox
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Brian Johnson
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Pamela Perry
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | | | - Robert D McQuade
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Margaretta Nyilas
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - William H Carson
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Romstadt N, Wonson E. Outcomes comparison of long-acting injectable antipsychotic initiation in treatment-naïve veterans in the inpatient versus outpatient setting. Ment Health Clin 2018; 8:24-27. [DOI: 10.9740/mhc.2018.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction:
Long-acting injectable (LAI) antipsychotics have become an integral component in the treatment of schizophrenia and other psychotic disorders. Long-acting injectables may be initiated in either the inpatient or outpatient setting; however, there have been no studies to evaluate whether LAI treatment initiation setting impacts patient outcomes. This study sought to assess whether outcomes, specifically psychiatric hospitalization rates, time to hospitalization, and adherence with injections, differed between patients started on LAIs in the inpatient versus outpatient setting.
Methods:
The electronic medical records of all veterans prescribed an LAI at the McGuire Veterans Affairs Medical Center from September 2009 through September 2014 were reviewed in this retrospective study. Veterans met inclusion criteria if they were prescribed an LAI during the study period and were excluded if they had received an LAI prior to September 2009 or if the LAI was started at an outside facility. Patients were separated into treatment groups according to initiation location. The primary outcomes included psychiatric hospitalization rates and time to hospitalization. The secondary outcome measured the proportion of LAI injections received.
Results:
Fifty-five LAI treatment-naïve veterans were included in this study. No statistically significant differences were found in psychiatric hospitalization rates, time to hospitalization, or proportion of LAI injections received when comparing the inpatient and outpatient treatment initiation groups.
Discussion:
Psychiatric hospitalization rates, time to hospitalization, and adherence to LAIs did not differ between the inpatient and outpatient treatment groups, suggesting that treatment initiation location does not have an effect on patient outcomes.
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Affiliation(s)
- Nicole Romstadt
- (Corresponding author) PGY1 Pharmacy Resident, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia,
| | - Erica Wonson
- Psychiatric Clinical Pharmacy Specialist, PGY2 Psychiatric Pharmacy Residency Program Director, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
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Quintero J, Oyagüez I, González B, Cuervo-Arango I, García I, Casado MA. Cost-Minimisation Analysis of Paliperidone Palmitate Long-Acting Treatment versus Risperidone Long-Acting Treatment for Schizophrenia in Spain. Clin Drug Investig 2016; 36:479-90. [PMID: 27000061 DOI: 10.1007/s40261-016-0393-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Long-acting formulations for paliperidone (PPLAT) and risperidone (RLAT) are effective second-generation antipsychotics. This study aimed to compare treatment costs between PPLAT and RLAT in schizophrenia patients. METHODS A cost-minimization analysis was performed from the perspective of the Spanish National Healthcare System (NHS), in line with the approach accepted by the Scottish Medicine Consortium evaluation. Only direct health costs (€, 2015) were included, i.e. medication (including oral antipsychotic drug supplementation), hospitalization and cost of administration in the community. Two time horizons were used: 1 year (to compare initiation treatment) and 2 years (to compare maintenance treatment). Base-case considered the following assumptions: setting for treatment initiation (50 % hospital and 50 % community); 50 % of patients initiating from a long-acting treatment and 50 % from an oral antipsychotic; no reduction in the length of stay. One-way sensitivity analyses (SA) were performed. RESULTS The estimated costs/patient were €7698 (PPLAT) and €8168 (RLAT) for the first year, and €4314 (PPLAT) and €5003 (RLAT) for the second year. Cost savings related to PPLAT therapy were €470 and €689 for first and second year, respectively. SA results confirmed the robustness of the model results, even in the most conservative scenarios: (1) if 100 % of patients initiate treatment in hospital, the savings could be €454 per patient; (2) if 100 % of patients initiate treatment from an oral antipsychotic, the savings could be €277 per patient/year; and (3) if PPLAT could not reduce the length of stay by approximately one-third, as some studies indicate, the savings could be €470 per patient/year. CONCLUSIONS The use of PPLAT instead of RLAT could be a cost-saving strategy for the Spanish NHS.
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Affiliation(s)
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Pº Joaquín Rodrigo 4I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | | | | | | | - Miguel Angel Casado
- Pharmacoeconomics & Outcomes Research Iberia, Pº Joaquín Rodrigo 4I, Pozuelo de Alarcón, 28224, Madrid, Spain
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Kim E, Correll CU, Mao L, Starr HL, Alphs L. Once-monthly paliperidone palmitate compared with conventional and atypical daily oral antipsychotic treatment in patients with schizophrenia. CNS Spectr 2016; 21:466-477. [PMID: 27629292 DOI: 10.1017/s1092852916000444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This analysis of the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study (NCT01157351) compared outcomes after administration of once-monthly paliperidone palmitate (PP) vs conventional oral antipsychotics (COAs) or atypical oral antipsychotics (AOAs). METHODS PRIDE was a 15-month study of 444 individuals with schizophrenia and a history of incarceration. They were randomly assigned to PP or to 1 of 7 commonly prescribed OAs. Primary endpoint was time to first treatment failure (TF). Event-free probabilities were estimated using the Kaplan-Meier method; treatment group differences (PP vs COAs, PP vs AOAs, and PP vs oral paliperidone/risperidone) were assessed using a log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. No adjustment was made for multiplicity. RESULTS Compared with PP, risk for first TF was 34% higher with COAs (HR: 1.34; 95% CI: 0.80-2.25), 41% higher with AOAs (HR: 1.41; 95% CI: 1.06-1.88), and 39% higher with paliperidone/risperidone (HR: 1.39; 95% CI: 0.97-1.99). Incidences of extrapyramidal symptom-related adverse events (AEs) were 45.7%, 13.7%, and 10.6% in the COA, AOA, and oral paliperidone/risperidone groups vs 23.9% in the PP group. Incidences of prolactin-related AEs were 5.7%, 3.8%, and 3.5% vs 23.5%, and incidences of ≥7% weight increase were 11.4%, 14.9%, and 16.0% vs 32.4%. CONCLUSIONS Results suggest a lower risk of TF but a higher rate of some AEs after treatment with PP vs COAs, AOAs, and paliperidone/risperidone. Deselection of specific OAs and low patient-compliance rates with OAs likely biased the safety results.
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Affiliation(s)
- Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Christoph U Correll
- Hofstra Northwell School of Medicine, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Lian Mao
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
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Safety and tolerability of long-acting injectable versus oral antipsychotics: A meta-analysis of randomized controlled studies comparing the same antipsychotics. Schizophr Res 2016; 176:220-230. [PMID: 27499361 DOI: 10.1016/j.schres.2016.07.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [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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Hodgson RE, Belgamwar RB, Walsh S. Long-acting aripiprazole (depot) versus placebo for schizophrenia. Hippokratia 2016. [DOI: 10.1002/14651858.cd012360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Richard E Hodgson
- North Staffordshire Combined Healthcare NHS Trust; Department of Psychiatry; Lyme Brook Centre Talke Road Stoke-on-Trent Staffordshire UK ST5 7TL
| | - Ravindra B Belgamwar
- North Staffordshire Combined Healthcare NHS Trust; Adult Psychiatry; Lymebrook Mental Health Centre Bradwell Hospital Site, Talke Road Newcastle-under-Lyme Staffordshire UK ST5 7TL
| | - Sally Walsh
- North Staffordshire Combined Healthcare NHS Trust; Harplands Hospital, Hilton Road Stoke-on-Trent UK ST4 6TH
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Einarson TR, Maia-Lopes S, Goswami P, Bereza BG, Van Impe K. Economic analysis of paliperidone long-acting injectable for chronic schizophrenia in Portugal. J Med Econ 2016; 19:913-21. [PMID: 27124697 DOI: 10.1080/13696998.2016.1184156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Patients with chronic schizophrenia suffer a huge burden, as do their families/caregivers. Treating schizophrenia is costly for health systems. The European Medicines Agency has approved paliperidone palmitate (PP-LAI; Xeplion), an atypical antipsychotic depot; however, its pharmacoeconomic profile in Portugal is unknown. A cost-effectiveness analysis was conducted from the viewpoint of the Portuguese National Health Service. METHODS PP-LAI was compared with long acting injectables risperidone (RIS-LAI) and haloperidol (HAL-LAI) and oral drugs (olanzapine; oral-OLZ) adapting a 1-year decision tree to Portugal, guided by local experts. Clinical information and costs were obtained from literature sources and published lists. Outcomes included relapses (both requiring and not requiring hospitalization) and quality-adjusted life-years (QALYs). Costs were expressed in 2014 euros. Economic outcomes were incremental cost-effectiveness ratios (ICERs); including cost-utility (outcome = QALYs) and cost-effectiveness analyses (outcomes = relapse/hospitalization/emergency room (ER) visit avoided). RESULTS The base-case cost of oral-OLZ was 4447€ (20% drugs/20% medical/60% hospital); HAL-LAI cost 4474€ (13% drugs/13% medical/74% hospital); PP-LAI cost 5326€ (49% drugs/12% medical/39% hospital); RIS-LAI cost 6223€ (44% drugs/12% medical/44% hospital). Respective QALYs/hospitalizations/ER visits were oral-OLZ: 0.761/0.615/0.242; HAL-LAI: 0.758/0.623/0.250; PP-LAI: 0.823/0.288/0.122; RIS-LAI: 0.799/0.394/0.168. HAL-LAI was dominated by oral-OLZ and RIS-LAI by PP-LAI for all outcomes. The ICER of PP-LAI over oral-OLZ was 14,247€/QALY, well below NICE/Portuguese thresholds (≈24,800€/30,000€/QALY). ICERs were 1973€/relapse avoided and 2697€/hospitalization avoided. Analyses were robust against most variations in input values, as PP-LAI was cost-effective over oral-OLZ in >99% of 10,000 simulations. CONCLUSION In Portugal, PP-LAI dominated HAL-LAI and RIS-LAI and was cost-effective over oral-OLZ with respect to QALYs gained, relapses avoided, and hospitalizations avoided.
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Affiliation(s)
- Thomas R Einarson
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | | | | | - Basil G Bereza
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
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Abstract
Schizophrenia and related disorders remain major disabling conditions, mainly due to antipsychotic treatment resistance and to relapses related to antipsychotic nonadherence. Treatment nonadherence rates are consistently high in long-term patients, but also in first-episode patients with schizophrenia. Long-acting injectable antipsychotics (LAIAs) were mainly developed to improve adherence to treatment and to reduce the rate of relapse and rehospitalization in schizophrenia due to treatment discontinuation. There is favorable clinical evidence, in terms of both efficacy and treatment adherence, that could support higher LAIA prescription rates, especially in patients in early phases of psychotic disorders. Several factors could be hindering wider use of LAIAs, mainly associated with perceptions and attitudes of patients, clinicians, and health managers or policy makers. The main aims of this review are (i) to summarize the existing data on the efficacy and tolerability of LAIAs compared with oral formulations in the management of schizophrenia and related disorders, focusing on the novel, second-generation LAIA options; (ii) to analyze the barriers that exist to the more widespread use of these formulations; and (iii) to discuss possible approaches to overcoming these barriers.
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Abstract
The optimal treatment for schizoaffective disorder (SCA) is not well established. In this initial 6-month open-label treatment period of a large, multiphase, relapse-prevention study, the efficacy and safety of paliperidone palmitate once-monthly (PP1M) injectable were evaluated in subjects with symptomatic SCA. Subjects with acute exacerbation of SCA (ie, with psychotic and either depressive and/or manic symptoms) were enrolled and treated with PP1M either as monotherapy or in combination with antidepressants or mood stabilizers (combination therapy group). After flexible-dose treatment with PP1M for 13 weeks, stabilized subjects continued into a 12-week fixed-dose PP1M treatment period. A total of 667 subjects were enrolled; 320 received monotherapy and 347 received PP1M as combination therapy; 334 subjects completed the entire 25-week treatment. Statistically significant and clinically meaningful improvements from baseline were observed for all efficacy measures in psychosis (per Positive and Negative Syndrome Scale), mood symptoms (per Young Mania Rating Scale and Hamilton Depression Rating Scale-21 items), and functioning (per Personal and Social Performance Scale) from week 1 to all time points during the 25-week treatment period (P < 0.001). Similar improvements in efficacy measures were observed between subjects receiving monotherapy or combination therapy. Efficacy benefits persisted throughout the 25-week period. The most common adverse events were akathisia (11.1%), injection-site pain (10.6%), and insomnia (10.0%). Paliperidone palmitate once-monthly administered as monotherapy or in combination with mood stabilizers or antidepressants in patients with an acute exacerbation of SCA provided rapid, broad, and persistent reduction in psychotic, depressive, and manic symptoms, as well as improved functioning.
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Bernardo M, Cañas F, Herrera B, García Dorado M. Adherence predicts symptomatic and psychosocial remission in schizophrenia: Naturalistic study of patient integration in the community. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 10:149-159. [PMID: 27291833 DOI: 10.1016/j.rpsm.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 03/22/2016] [Accepted: 04/21/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Psychosocial functioning in patients with schizophrenia attended in daily practice is an understudied aspect. The aim of this study was to assess the relationship between symptomatic and psychosocial remission and adherence to treatment in schizophrenia. METHODS This cross-sectional, non-interventional, and multicenter study assessed symptomatic and psychosocial remission and community integration of 1,787 outpatients with schizophrenia attended in Spanish mental health services. Adherence to antipsychotic medication in the previous year was categorized as≥80% vs.<80%. RESULTS Symptomatic remission was achieved in 28.5% of patients, and psychosocial remission in 26.1%. A total of 60.5% of patients were classified as adherent to antipsychotic treatment and 41% as adherent to non-pharmacological treatment. During the index visit, treatment was changed in 28.4% of patients, in 31.1% of them because of low adherence (8.8% of the total population). Adherent patients showed higher percentages of symptomatic and psychosocial remission than non-adherent patients (30.5 vs. 25.4%, P<.05; and 32 vs. 17%, P<.001, respectively). Only 3.5% of the patients showed an adequate level of community integration, which was also higher among adherent patients (73.0 vs. 60.1%, P<.05). CONCLUSIONS Adherence to antipsychotic medication was associated with symptomatic and psychosocial remission as well as with community integration.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | | | - Berta Herrera
- Medical Affairs Department, Janssen-Cilag, S. A., Madrid, España.
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Fagiolini A, Alfonsi E, Amodeo G, Cenci M, Di Lella M, Farinella F, Ferraiuolo F, Fraguas D, Loparco N, Gutierrez-Rojas L, Mignone ML, Pataracchia G, Pillai G, Russo F, Sanchez-Gistau V, Spinogatti F, Toscano M, Villari V, De Filippis S. Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists. Expert Opin Drug Saf 2016; 15:449-55. [DOI: 10.1517/14740338.2016.1155553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea Fagiolini
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Emilia Alfonsi
- Department of Mental Health, National Health Service, Ancona, Italy
| | - Giovanni Amodeo
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Mario Cenci
- Department of Mental Health, Fabriano, Italy
| | - Michele Di Lella
- Department of Mental Health, National Health Service, Alessandria, Italy
| | | | | | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Madrid, Spain
| | - Natale Loparco
- Department of Mental Health, National Health Service, Taranto, Italy
| | - Luis Gutierrez-Rojas
- Departamento de Psiquiatría, Hospital Clínico, Granada - Complejo Hospitalario Granada, Granada, Spain
| | | | | | - Gianluca Pillai
- Department of Mental Health, National Health Service, Oristano, Italy
| | - Felicia Russo
- Servizio Psichiatrico di Diagnosi e Cura, Ospedale F. Fallacara, Triggiano and Department of Mental Health, National Health Service, Bari, Italy
| | - Vanessa Sanchez-Gistau
- Early Intervention Psychosis Service, Hospital Universitari Insitut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Franco Spinogatti
- Department of Mental Health, National Health Service, Cremona, Italy
| | - Marco Toscano
- Department of Mental Health, ASST Rhodense, Garbagnate M.se, Italy
| | - Vincenzo Villari
- Department of Mental Health, National Health Service, Torino, Italy
| | - Sergio De Filippis
- Casa di Cura Neuropsichiatrica e Comunità Terapeutica-Genzano, University of Rome and Villa Von Siebenthal, Rome, Italy
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Jones ME, Andrews JS, Faries DE, Landry J, Xu J, Detke HC, Chhabra-Khanna R, McDonnell DP. Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study. BMC Psychiatry 2015; 15:278. [PMID: 26567159 PMCID: PMC4644333 DOI: 10.1186/s12888-015-0669-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Depot antipsychotics are a treatment option for medication nonadherence in patients with schizophrenia. Nonadherence can lead to increased relapse and hospitalization rates. This article reports hospitalization data before and after initiation of olanzapine long-acting injection (LAI), a depot antipsychotic. METHODS Data were assessed from an ongoing, multinational, prospective, observational post-authorisation safety study being conducted to evaluate post-injection delirium/sedation syndrome (PDSS), an adverse reaction that can occur following injection of olanzapine LAI. Eligible patients were aged ≥18 years, diagnosed with schizophrenia, were prescribed olanzapine LAI, and lived outside the United States. Psychiatric hospitalization and medication data were collected retrospectively for the 6-month period before study entry and prospectively throughout the study. Paired t-tests and McNemar's tests were used to assess changes in hospitalization incidence and duration. Stepwise Cox proportional hazards models assessed factors associated with hospitalizations. Analyses were based on data from the first 3 years of the continuously enrolling study (N = 668). RESULTS The average duration of olanzapine LAI exposure for all patients was 0.768 years. Of the 529 patients who received at least 1 injection of olanzapine LAI and were not hospitalized at study entry, 8.1% had at least 1 subsequent psychiatric hospitalization with a mean duration of 2.0 days. Of the 288 patients who had a >6-month follow-up, 8.3% had at least 1 post-baseline psychiatric hospitalization with a mean duration of 2.3 days. The incidence of hospitalizations in the 6-month period after treatment was significantly lower than that in the 6-month period prior to treatment (8.3 vs 32.6%, respectively; P < 0.001). Furthermore, mean hospitalization duration decreased from 11.5 days in the 6-month period before treatment to 2.3 days in the 6-month period after treatment (P < 0.001). Psychiatric hospitalization in the prior 12 months (P < 0.0001) and recreational drug use within 24 h of baseline visit (P = 0.015) were identified as potential predictors of time to first psychiatric hospitalization after beginning to take olanzapine LAI. At the time of interim analysis, 5 PDSS events had occurred, which was too few for a full analysis of those events. CONCLUSIONS Results indicate a significant reduction in the incidence and days of hospitalization from the 6-month period before to the 6-month period after olanzapine LAI initiation, which suggests reduced relapse and hospitalization during treatment. Results should be interpreted with caution due to the observational nature of the study and use of retrospective baseline data.
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Affiliation(s)
| | | | | | - John Landry
- Eli Lilly Canada, Inc., Toronto, ON, M1N 2E8, Canada.
| | - Jenny Xu
- MacroStat (China) Clinical Research Co., Ltd., Shanghai, China.
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Özdemir AK, Pak ŞC, Canan F, Geçici Ö, Kuloğlu M, Gücer MK. Paliperidone palmitate use in pregnancy in a woman with schizophrenia. Arch Womens Ment Health 2015; 18:739-40. [PMID: 25599999 DOI: 10.1007/s00737-014-0496-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/24/2014] [Indexed: 11/26/2022]
Abstract
Long-acting antipsychotic use in schizophrenia has become an advantage for treatment compliance and convenient administration of the drugs. There is no data on paliperidone palmitate (PP) use in pregnancy, which is the longest-acting (i.e., 1 month) atypical antipsychotic. In this case report, we aim to present a patient diagnosed with schizophrenia who had been using PP before and during her pregnancy until week 28 of gestation and gave birth to a male baby that weighed 3000 g at 39 weeks. As far as we know, this is the first case report on PP use during pregnancy.
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Affiliation(s)
- Aslı Karadağ Özdemir
- Department of Psychiatry, Akdeniz University School of Medicine, Kampüs, 07059, Antalya, Turkey
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Smith JP, Herber OR. Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long-acting intramuscular injections: a qualitative study. Int J Ment Health Nurs 2015; 24:222-30. [PMID: 25394562 DOI: 10.1111/inm.12105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The ethical issues experienced by mental health nurses in administering antipsychotic depot and long-acting intramuscular injections (LAI) were explored in the present study. Mental health nurses face ethically-difficult situations when administering these medications. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical issues involved in performing the procedure. Purposive and snowball sampling was used to select eight participants from two mental health hospitals. Semistructured interviews were carried out to collect data. A thematic analysis was conducted on the data. The four main themes that emerged from the analyses were: (i) lack of alternatives; (ii) safety; (iii) feeling uncomfortable; and (iv) difficulty maintaining the therapeutic relationship. The findings suggest that mental health nurses face ethical challenges in administering LAI. The findings raise much needed awareness of the need for mental health nurses and nurse educators to consider the ethical issues experienced while performing the procedure. There is a need for nurse education providers and organizations to provide opportunities for mental health nurses to address their 'lived experiences'. Educational courses are needed to equip mental health nurses with the technical and critical thinking skills to administer safe and effective antipsychotic depot and LAI.
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Affiliation(s)
- James Paul Smith
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - Oliver Rudolf Herber
- School of Nursing and Midwifery, University of Dundee, Dundee, UK.,Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Kulkarni J, Reeve-Parker K. Psychiatrists' awareness of partial- and non-adherence to antipsychotic medication in schizophrenia: results from the Australian ADHES survey. Australas Psychiatry 2015; 23:258-64. [PMID: 25783668 DOI: 10.1177/1039856215576396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Adherence in Schizophrenia (ADHES) initiative aimed to assess physicians' perspectives about treatment adherence in people with schizophrenia, and assess strategies to improve adherence. METHODS Between March and April 2012, a 20-question survey was delivered to Australian psychiatrists (n = 3400). These anonymous surveys were returned by mail. The survey asked about the demographics of participating psychiatrists and the respondents' perceptions of different factors that affect the adherence of people with schizophrenia to their treatment with antipsychotic medications. Adherence was defined by the proportion of prescribed doses taken: non-adherence, if < 30%; partial-adherence, 30%-90%; and adherent, > 90%. Data were reported descriptively and were not weighted. RESULTS Respondent psychiatrists (n = 406; response rate 12%) reported that one-half (51%) of people with schizophrenia were either non-adherent (20%) or only partially adherent (31%). This was despite most (72%) psychiatrists' reporting that they assessed adherence to medication at every visit. The main reported reasons for medication discontinuation were: lack of insight (45%), drug or alcohol abuse (3%), or side effects (29%). The preferred strategies for improving adherence were switching to or adding a long-acting antipsychotic (40%), or simplifying the medication regimen (30%). CONCLUSIONS Lack of adherence to antipsychotic medication remains a problem. More proactive management is required, to improve adherence and long-term outcomes.
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Chiou CF, Wang BC, Caldwell R, Furnback W, Lee JS, Kothandaraman N, Lee S, Wang J, Zhang F. The cost reduction in hospitalization associated with paliperidone palmitate in the People's Republic of China, Korea, and Malaysia. Neuropsychiatr Dis Treat 2015; 11:1989-94. [PMID: 26346330 PMCID: PMC4531005 DOI: 10.2147/ndt.s86722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Schizophrenia results in substantial health care utilization costs. Much of these costs can be attributed to health care use resulting from nonadherence to treatment, relapse, and hospitalization. AIMS OF THE STUDY The objective of this research is to further estimate the health care resource utilization costs of patients with schizophrenia in the People's Republic of China, Korea, and Malaysia with a specific focus on the reduction in hospitalization costs associated with the use of long-acting, injectable paliperidone palmitate (PP) relative to alternative treatment medications. METHODS The study focuses exclusively on the estimated reduction in hospitalization days following treatment with PP and the potential associated cost savings. Cost analysis was done using a payer's perspective and only includes direct health care costs associated with hospitalization. Localized cost data were taken from published sources, and health care utilization was estimated based on a clinical study conducted in countries in the Asia-Pacific region. People's Republic of China, Korea, and Malaysia had the highest number of patients enrolled in the clinical study, and thus were chosen for this research. Analysis looked at 12-month and 18-month periods following initial treatment with PP relative to a retrospective 12-month period utilizing alternative treatment medications. RESULTS Results suggest that reductions in hospital utilization cost over 12 months may occur through the use of PP relative to alternatives-ranging from $1,991 for the People's Republic of China to $6,698 for Korea and $6,716 for Malaysia. CONCLUSION Given the substantial costs associated with the treatment of schizophrenia both worldwide and in Asia, it is important to fully understand the costs and outcomes associated with various treatment options. In this research, we have specifically analyzed the direct health care cost savings associated with hospital utilization for patients taking PP relative to alternative treatment methods. The results suggest that reductions in hospital utilization cost were associated with PP treatment, likely largely due to increased adherence to treatment.
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Affiliation(s)
| | | | - Ronald Caldwell
- Department of Economics, University of Michigan, Ann Arbor, MI, USA
| | | | - Jung-Sun Lee
- Department of Psychiatry, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | - Jin Wang
- Strategy and Development, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
| | - Fan Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People's Republic of China
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Si T, Zhang K, Tang J, Fang M, Li K, Zhuo J, Feng Y. Efficacy and safety of flexibly dosed paliperidone palmitate in Chinese patients with acute schizophrenia: an open-label, single-arm, prospective, interventional study. Neuropsychiatr Dis Treat 2015; 11:1483-92. [PMID: 26150719 PMCID: PMC4484695 DOI: 10.2147/ndt.s81760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This open-label, single-arm, multicenter, 13-week, prospective study explored the efficacy, safety, and tolerability of paliperidone palmitate (150 milligram equivalents [mg eq] [day 1], 100 mg eq [day 8], both deltoid injections; 75-150 mg eq, deltoid/gluteal injection) in Chinese patients with acute schizophrenia (Positive and Negative Syndrome Scale [PANSS] total score ≥70), who previously had unsatisfactory therapeutic effect following oral antipsychotic treatment (without washout period). Primary efficacy endpoint was percentage of patients with ≥30% improvement in the PANSS total score at the end of 13 weeks. Secondary efficacy endpoints included change from baseline to end of week 13 in PANSS total score, PANSS subscale scores, Marder factor scores, Clinical Global Impressions-Severity score, and Personal and Social Performance Scale scores. Overall, 477/610 enrolled patients (full analysis set, 78.2%) completed the study (men: 55.1%; women: 44.9%; mean age: 31.5 years). Total, 443/610 (72.6%, full analysis set) patients achieved primary endpoint (mean [standard deviation] change from baseline: -30.9 [19.51]). All secondary endpoints demonstrated significant improvement at the end of 13 weeks. One death occurred during this acute phase. The most common (>5%) treatment-emergent adverse events were extrapyramidal disorders (8.4%). The efficacy and safety data are consistent with other short-term, placebo-controlled studies of paliperidone palmitate conducted in similar populations.
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Affiliation(s)
- Tianmei Si
- Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Beijing, People's Republic of China
| | - Kerang Zhang
- Shanxi Medical University First Hospital, Shanxi, People's Republic of China
| | - Jisheng Tang
- Mental Health Center of Shandong Province, Shandong, People's Republic of China
| | - Maosheng Fang
- Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Hubei, People's Republic of China
| | - Keqing Li
- Mental Health Center of Hebei Province, Hebei, People's Republic of China
| | - Jianmin Zhuo
- Janssen Research and Development, Beijing, People's Republic of China
| | - Yu Feng
- Janssen Research and Development, Beijing, People's Republic of China
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