Comparison and predictors of treatment adherence and remission among patients with schizophrenia treated with paliperidone palmitate or atypical oral antipsychotics in community behavioral health organizations

Abstract

BackgroundNonadherence to antipsychotic treatment increases the likelihood of relapse and progressive symptomatology in patients with schizophrenia. Atypical long-acting injectables, including paliperidone palmitate (PP), may increase adherence and improve symptoms. This study compared and assessed predictors of treatment patterns and symptom remission among schizophrenia patients treated with PP versus atypical oral antipsychotic therapy (OAT) in community behavioral health organizations (CBHOs).MethodsThis retrospective cohort analysis evaluated 763 patients with schizophrenia and new (PP-N; N = 174) or continuing (PP-C; N = 308) users of PP, or new users of OAT (N = 281) at enrollment in the REACH-OUT study (2010–2013). Treatment outcomes assessed at 1 year were discontinuation, and adherence, measured by proportion of days covered (PDC) or medication possession ratio (MPR). Remission status was assessed using the Structured Clinical Interview for Symptoms of Remission (SCI-SR). A machine learning platform, Reverse Engineering and Forward Simulation (REFS™), was used to identify predictors of study outcomes. Multivariate Cox and generalized linear regressions estimated the adjusted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals.ResultsAmong PP-N users, 27% discontinued their initial treatment regimen versus 51% (p < 0.001) of OAT users. PP-N (vs OAT; HR = 0.49 [0.31–0.76]) users and males (HR = 0.65 [0.46–0.92]) had significantly lower rates of discontinuation. Relative to OAT, PP-N had a 36% [31%–42%] higher MPR and a 10-fold increased achievement of PDC ≥80% (OR = 10.46 [5.72–19.76]). PP users were significantly more likely to achieve remission in follow-up (PP-N vs OAT: OR = 2.65 [1.39–5.05]; PP-C vs OAT: OR = 1.83 [1.03–3.25]).ConclusionsRelative to OAT, PP was associated with improved adherence, less frequent treatment discontinuation, and improved symptom remission in this CBHO study population.

Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis

“…The present study of the VHA database found that, among patients switching from oral RIS/PALI therapy to PP1M, those with schizophrenia had higher adherence, with lower HRU and no increase in all-cause total costs. The current analysis provides evidence that patients treated with LAI APs experienced improved adherence and significantly lower total medical costs compared with oral AP therapy, which is associated with relatively low levels of treatment adherence, 18 , 19 , 20 high HRU, 21 , 22 and high costs. 12 , 23 The design of the current study allows a direct comparison of how costs changed in the same patients before and after switching from an oral AP to an LAI with a similar mechanism of action.…”

Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

“…Conflicting results were reported by Anderson et al . in a retrospective cohort analysis evaluating a relatively high number of subjects diagnosed with SCZ spectrum disorders . The authors concluded that PP1M was associated with lower treatment discontinuation rate compared with oral antipsychotics.…”

“…The only study reporting the advantage of PP1M on oral antipsychotics showed several limitations, the main being a suboptimal statistical power due to the small sample size and the inclusion in the study cohort of both new and old PP1M users . The main causes of drug discontinuation before the planned study end were adverse events and ineffectiveness .…”

“…47,[49][50][51]53,55 The only study reporting the advantage of PP1M on oral antipsychotics showed several limitations, the main being a suboptimal statistical power due to the small sample size and the inclusion in the study cohort of both new and old PP1M users. 54 The main causes of drug discontinuation before the planned study end were adverse events 45,46,61,62,65 and ineffectiveness. 47,51,59,62,65,66 The two available long-term studies on PPM3 showed a rate of premature discontinuation similar to that shown by the active comparator (PP1M).…”

Artificial Intelligence in Pharmacoepidemiology: A Systematic Review. Part 1—Overview of Knowledge Discovery Techniques in Artificial Intelligence

“…To predict adherence to pharmacological treatments 1) Anderson et al used a Bayesian network to identify predictors of treatment adherence in patients with schizophrenia treated with atypical antipsychotics (Anderson et al, 2017).…”