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Taipale H, Lieslehto J, Lähteenvuo M, Hamina A, Tanskanen A, Mittendorfer-Rutz E, Paljärvi T, Solmi M, Cipriani A, Correll CU, Tiihonen J. Real-world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within-subject analyses of two nationwide cohorts. World Psychiatry 2024; 23:276-284. [PMID: 38727044 PMCID: PMC11083867 DOI: 10.1002/wps.21205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Psychotic depression (PD) is a severe mental disorder leading to functional disability and high risk of suicide, but very little is known about the comparative effectiveness of medications used in its maintenance treatment. The objective of this study was to investigate the comparative effectiveness of specific antipsychotics and antidepressants, and their combinations, on the risk of psychiatric hospitalization among persons with PD in routine care. Persons aged 16-65 years with a first-time diagnosis of PD were identified from Finnish (years 2000-2018) and Swedish (years 2006-2021) nationwide registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. The main exposures were specific antipsychotics and antidepressants, and the main outcome measure was psychiatric hospitalization as a marker of severe relapse. The risk of hospitalization associated with periods of use vs. non-use of medications (expressed as adjusted hazard ratio, aHR) was assessed by a within-individual design, using each individual as his/her own control, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately, and then combined using a fixed-effect meta-analysis. The Finnish cohort included 19,330 persons (mean age: 39.8±14.7 years; 57.9% women) and the Swedish cohort 13,684 persons (mean age: 41.3±14.0 years; 53.5% women). Individual antidepressants associated with a decreased risk of relapse vs. non-use of antidepressants were bupropion (aHR=0.73, 95% CI: 0.63-0.85), vortioxetine (aHR=0.78, 95% CI: 0.63-0.96) and venlafaxine (aHR=0.92, 95% CI: 0.86-0.98). Any long-acting injectable antipsychotic (LAI) (aHR=0.60, 95% CI: 0.45-0.80) and clozapine (aHR=0.72, 95% CI: 0.57-0.91) were associated with a decreased risk of relapse vs. non-use of antipsychotics. Among monotherapies, only vortioxetine (aHR=0.67, 95% CI: 0.47-0.95) and bupropion (aHR=0.71, 95% CI: 0.56-0.89) were associated with a significantly decreased risk of relapse vs. non-use of both antidepressants and antipsychotics. In an exploratory analysis of antidepressant-antipsychotic combinations, a decreased relapse risk was found for amitriptyline-olanzapine (aHR=0.45, 95% CI: 0.28-0.71), sertraline-quetiapine (aHR=0.79, 95% CI: 0.67-0.93) and venlafaxine-quetiapine (aHR=0.82, 95% CI: 0.73-0.91) vs. non-use of antidepressants and antipsychotics. Benzodiazepines and related drugs (aHR=1.29, 95% CI: 1.24-1.34) and mirtazapine (aHR=1.17, 95% CI: 1.07-1.29) were associated with an increased risk of relapse. These data indicate that, in the maintenance treatment of PD, bupropion, vortioxetine, venlafaxine, any LAI, clozapine, and only few specific antidepressant-antipsychotic combinations are associated with a decreased risk of relapse. These findings challenge the current recommendation by treatment guidelines to combine an antipsychotic with an antidepressant (without further specification) as standard treatment in PD.
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Affiliation(s)
- Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Johannes Lieslehto
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Aleksi Hamina
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Tapio Paljärvi
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Regional Centre for Treatment of Eating Disorders and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Neuroscience Center, University of Helsinki, Helsinki, Finland
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Mastelić T, Borovina Marasović T, Rakušić M, Martinović D, Lasić D, Uglešić B, Glavina T. Rehospitalization Rates Among Patients with Psychotic Disorders During Covid-19 Pandemic: Oral Versus Long-Acting Injectable Antipsychotics. Clin Neuropsychiatry 2022; 19:365-369. [PMID: 36627948 PMCID: PMC9807113 DOI: 10.36131/cnfioritieditore20220603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective The superiority of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics is often emphasized, even in terms of adherence and rehospitaliza-tion rates. As such, LAIs are particularly recommended during the COVID-19 pandemic. The goal of our research was to determine whether there are differences in the number of rehospitalizations in patients treated for schizophrenia, schizophrenia-like disorders, and delusional states (psychotic disorders) with LAI antispychotics versus oral antispychotics. Method Subjects with schizophrenia, schizophrenia-like disorders and delusional states participated in our retrospective study. 124 subjects were treated with oral anti-psychotics, while 72 received LAIs along with oral antipsychotics. We collected their sociodemographic data and psychiatric history data. Our main outcome measure was the number of rehospitalizations. Results Statistical analysis showed that the studied groups did not differ according to sociodemographic parameters, except that in the group of patients with LAIs there was a significantly higher percentage of men (65 (52.4) vs 50 (69.4), p=0.029)). Also, the groups do not differ according to the psychiatric history data. There is no difference in the duration of the current hospitalization nor in the composition of the patients, considering the order of the current hospitalization. The difference in the number of rehospitalizations is not significant neither in the first year of follow-up (p=0.144), nor in the second (p=0.142), nor after two years of follow-up (p=0.083). Conclusions Our research has shown that there is no difference in the number of rehospitalizations in patients with schizophrenia, schizophrenia-like disorders and delusional states, considering whether they take oral antipsychotics or they also take LAIs along with them. We can therefore conclude that it is particularly important to work on improving patient adherence. We must make psychiatrists aware that the pandemic, like other threats, can be our ally in improving adherence ("perceived threat as a health belief").
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Affiliation(s)
- Tonći Mastelić
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Tonka Borovina Marasović
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia,Corresponding author Tonka Borovina Marasović MD Clinic for Psychiatry University Hospital Centre Split, Croatia Spinčićeva 1, 21 000 Split, Croatia Tel.:+38521556132 E-mail:
| | - Mihaela Rakušić
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Dinko Martinović
- Department of Pathophysiology, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - Davor Lasić
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Boran Uglešić
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Trpimir Glavina
- Clinic for Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21 000 Split, Croatia
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Sun Y, Tong J, Feng Y, Fang H, Jiang T, Zhao L, Wang Q, Yang Y. Attitude and influencing factors of patients with schizophrenia toward long-acting injections: A community-based cross-sectional investigation in China. Front Public Health 2022; 10:951544. [PMID: 36299738 PMCID: PMC9589343 DOI: 10.3389/fpubh.2022.951544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Low prescription rates of antipsychotic long-acting injections (LAIs) may be a major challenge in the prevention and treatment of schizophrenia. However, there are few studies on the usage and attitude toward LAIs among community-based patients with schizophrenia. Methods A large community-based cross-sectional investigation was conducted among 6,336 patients with schizophrenia from Shanghai, China from March 1 to June 30, 2021. The structured Attitude and Status toward Treatment of Community Patients with Schizophrenia Questionnaire (AST-CSQ) was used to investigate the attitude and influencing factors of community-dwelling patients with schizophrenia toward LAIs. Results Among the 6,336 participants, the average age was 49.28 ± 11.23. The rate of agreement to LAI antipsychotics among participants was 3.16% (n = 200). The family financial resources, care ability, and disease course of the LAIs group were less than those of the non-LAIs group. However, the LAIs group had higher immediate family guardianship, social activity, previous hospitalization, number of hospitalization, outpatient adherence, previous antipsychotic use, antipsychotic adherence, and attitude toward oral antipsychotics than the non-LAIs group, with significant differences between the two groups (p < 0.05). Furthermore, age (β = -0.036, OR 0.964, 95% CI 0.947-0.982), marital status (β = 0.237, OR 1.267, 95% CI 1.002-1.602), care ability (β = 0.709, OR 2.032, 95% CI 1.437-2.875), outpatient adherence (β = -0.674, OR 0.510, 95% CI 0.358-0.725), antipsychotic adherence (β = 0.920, OR 2.509, 95% CI 1.092-5.764), and attitude toward oral antipsychotics (β = -1.357, OR 0.258, 95% CI 0.103-0.646) were significant predictors of attitude toward LAI antipsychotics (p < 0.05). Conclusions The community-dwelling patients with schizophrenia in China had a low willingness to use LAIs. Patients of a younger age, more hospitalizations, and a shorter course of disease were prone to be more willing to accept LAIs. The patients' age, marital status, care ability, outpatient adherence, antipsychotic adherence, and attitude toward oral antipsychotics were important predictor of patients' attitudes toward LAIs. Under the global deinstitutionalized management model of mental disorders, these results highlight an urgent problems for public mental health service providers and policy-makers and provide more solutions for them.
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Affiliation(s)
- Yiying Sun
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Jie Tong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ying Feng
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Haiping Fang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Tao Jiang
- Shanghai Yangjing Community Health Service Center, Shanghai, China
| | - Liping Zhao
- Shanghai Sanlin Community Health Service Center, Shanghai, China
| | - Qiang Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,Qiang Wang
| | - Yi Yang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,*Correspondence: Yi Yang
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Paton C, Okocha CI, Patel MX. Can the use of long-acting injectable antipsychotic preparations be increased in routine clinical practice and the benefits realised? Ther Adv Psychopharmacol 2022; 12:20451253211072347. [PMID: 35186261 PMCID: PMC8854225 DOI: 10.1177/20451253211072347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The use of continuing antipsychotic medication is an established evidence-based strategy for preventing relapse in people with schizophrenia, but medication adherence is known to be suboptimal. Covert non-adherence can be eliminated by the use of long-acting injectable (LAI) formulations. We sought to (1) raise awareness among clinicians of the potential benefits of LAI antipsychotic formulations, (2) increase use of these formulations for the treatment of schizophrenia in routine clinical practice and thereby (3) reduce the number of relapses requiring hospitalisation in patients with schizophrenia under our care. METHOD Educational initiatives, promotion of reflective practice and patient-specific reminders were used to prompt increased use of LAI antipsychotic medication for patients with schizophrenia. Data relating to the use of these medications and the number of acute admissions for schizophrenia spectrum disorders (F20-29, ICD-10) over time were extracted from existing clinical information systems. RESULTS Over the 3-year time frame of our local initiative, the use of LAI antipsychotic preparations increased by 11%, the number of acute admissions for schizophrenia/schizoaffective disorder (F20 and F25) decreased by 26% and the number of acute bed days occupied by patients with these diagnoses decreased by 8%. The number of admissions for other psychosis diagnoses (F21-24 and F28-29) did not show the same pattern of improvement. CONCLUSION In our health care organisation, raising clinicians' awareness of the evidence base relating to the potentially favourable benefit-risk balance for LAI antipsychotic medication compared with oral formulations resulted in more use of the former. There were accompanying reductions in acute admissions and occupied bed days for patients with schizophrenia.
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Affiliation(s)
- Carol Paton
- Oxleas NHS Foundation Trust, Pinewood House, Pinewood Place, Dartford DA5 2DX, Kent, UK Centre for Psychiatry, Imperial College London, London, UK
| | | | - Maxine X. Patel
- Oxleas NHS Foundation Trust, Dartford, UK; Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Walling DP, Hassman HA, Anta L, Ochoa L, Ayani I, Martínez J, Gutierro I. The Steady-State Comparative Bioavailability of Intramuscular Risperidone ISM and Oral Risperidone: An Open-Label, One-Sequence Study. Drug Des Devel Ther 2021; 15:4371-4382. [PMID: 34703212 PMCID: PMC8526518 DOI: 10.2147/dddt.s332026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
Introduction This open-label, one-sequence study evaluated the steady-state comparative bioavailability of risperidone in situ microimplants (ISM®) and oral risperidone in patients stabilized on oral risperidone treatment. Methods Repeat oral administration of once daily 4 mg risperidone for 7 days was followed by 4 monthly (once every four weeks) intramuscular (IM) doses of risperidone ISM 100 mg. Mean steady-state concentration versus time profiles for risperidone, 9-OH risperidone, and risperidone active moiety was characterized. Results A total of 104 subjects were enrolled, 81 were included in the safety population and 58 completed the study. Intersubject variability for the steady-state concentrations versus time profiles for risperidone active moiety presented a greater variability range for oral risperidone versus risperidone ISM (% coefficient of variation [CV] range: 40–65% and 38–52%, respectively). Minimum plasma concentration at steady-state (Cmin, ss) and fluctuation in plasma concentrations (Fluc) of risperidone active moiety after risperidone ISM administration met bioequivalence criteria compared to the reference oral risperidone (geometric mean ratio [GMR] = 1.09 and 0.96, respectively; both 90% CIs were within 0.80–1.25). Area under the curve during the dosing interval (AUCtau), maximum plasma concentration at steady-state (Cmax, ss) and average plasma concentration (Cave) were only slightly higher (GMR [90% CI] = 1.25 [1.16–1.34], 1.17 [1.08–1.27], and 1.25 [1.16–1.34], respectively). Overall, once daily oral risperidone 4 mg and once monthly IM risperidone ISM 100 mg were generally safe and well tolerated in the participating subjects with schizophrenia previously stabilized with oral risperidone. Conclusion The rapid release of risperidone ISM allows the achievement of the desired levels similar to those observed at the steady-state after oral risperidone treatment. Therefore, direct switch after 24 hours from the last oral risperidone dose to risperidone ISM treatment can be done in schizophrenia patients with no time lag, maintaining steady-state levels of the active moiety throughout treatment and without the need for oral risperidone supplementation or loading doses.
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Affiliation(s)
- David P Walling
- Collaborative Neuroscience Network, LLC Garden Grove, Garden Grove, CA, USA
| | | | - Lourdes Anta
- Medical Department, Laboratorios Farmacéuticos ROVI, S.A., Madrid, Spain
| | - Lourdes Ochoa
- R&D Department, Laboratorios Farmacéuticos ROVI, S.A., Madrid, Spain
| | - Ignacio Ayani
- Medical Department, Laboratorios Farmacéuticos ROVI, S.A., Madrid, Spain
| | - Javier Martínez
- Medical Department, Laboratorios Farmacéuticos ROVI, S.A., Madrid, Spain
| | - Ibon Gutierro
- R&D Department, Laboratorios Farmacéuticos ROVI, S.A., Madrid, Spain
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Budovich A, Claudio-Saez MM, Hershberger J. Savings on High-Cost Drugs Such as Atypical Long-Acting Injectable Antipsychotics: Switching to Billing Under the Pharmacy Benefit in Outpatient Settings. P T 2019; 44:474-496. [PMID: 31447535 PMCID: PMC6679951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Access to health care can be improved by controlling and optimizing expenditures, specifically the high-cost drugs such as atypical long-acting injectable (LAI) antipsychotics. This type of LAI is usually covered under the medical benefit and/or pharmacy benefit. We sought to compare financial outcomes of the medical benefit billing option with the pharmacy benefit billing option for atypical LAIs in an adult outpatient psychiatric clinic and to determine insurance companies' reasons for nonpayment when the medical benefit billing model was utilized. METHODS A retrospective chart review with patients 18 years of age and older who were receiving atypical LAI antipsychotics in the outpatient psychiatric department during two time periods--January 7 through February 6, 2016 and August 15 through September 14, 2016--to evaluate medical (N = 31) and pharmacy (N = 23) benefit study periods, respectively. RESULTS The estimated loss when using the medical benefit billing option was $14,520 per month. Switching to billing under the pharmacy benefit resulted in a monthly gain of $2,100. The net savings from the switch were estimated at $16,620 per month. No patient lost access to treatment or was switched to another medication solely because of the change in billing option. The reasons for nonpayment (N = 10) provided by medical insurance companies were prior authorization/step therapy required (40%), insurance terminated (30%), and coverage through Medicaid Rx only (30%). CONCLUSION This study revealed a significant financial loss related to atypical LAI antipsychotics when the medical benefit model was utilized. By switching to billing under the pharmacy benefit, potential savings for high-cost drugs such as LAIs can be realized.
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