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

Abstract

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

Antipsychotics, the heartland of clinical psychopharmacology?

“…Paliperidone palmitate is currently the only LAI that can be administered at 3 monthly intervals for maintenance treatment of schizophrenia. They found that overall, most patients initiated on PP3M in this prospective clinical setting study continued treatment and remained well (Wallman et al, 2021). This is concordant with previous RCTs of PP3M and with naturalistic studies.…”

Real-life effectiveness of transitioning from paliperidone palmitate 1-monthly to paliperidone palmitate 3-monthly long-acting injectable formulation

“…Other naturalistic studies have been conducted, but as previously discussed, there are many issues that hinder their comparability with the present findings. [9][10][11] The study with the most comparable methodological design to the present one is that reported by Wallman et al 13 and Clark et al 14 in which relapse rates of 7.2% and 10.8% were found during the 2 years following PP3M initiation, which is much lower than the relapse rate herein reported. A first explanation for these lower rates than that obtained here are the different definitions of relapse used.…”

“…This is an important consideration given that Ferraro et al 12 found a very high relapse rate of 35.7% within a sample of FEP patients, a population in which comorbid psychiatric diagnoses are the norm rather than the exception. Unfortunately, rates of comorbid diagnoses were not reported by Wallman et al 13 nor by Clark et al, 14 making it impossible to compare their population with that of the present study on that crucial aspect.…”

“…A fifth study that was reported in two separate papers described the outcomes of a prospective cohort of consecutive patients switched from PP1M to PP3M. Wallman et al 13 limited their analyses to patients with schizophrenia diagnoses only and found that only 8 patients (7.2%) among 111 had relapsed during the 2 years following PP3M initiation. Clark et al 14 included in their analyses patients with diagnoses other than schizophrenia and examined factors associated with relapse.…”

Olanzapine long-acting injection, discontinuation rates and reasons for discontinuation: 10 years’ experience at a UK high-secure hospital

“…26 At 2 years, 42% of 225 patients TherapeuTic advances in psychopharmacology prescribed monthly paliperidone LAI continued their medication and 60% of 111 patients prescribed 3-monthly paliperidone LAI continued with their medication. 27,28 The authors of the 3 monthly LAI study attributed the better rates to patients having been previously stable on monthly Paliperidone. We add to this information, reporting OLAI continuation at 2 years as 51% of 88 patients and at 60 months as 31% of 70 patients.…”