Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis

Abstract

Background: The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. Methods: Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre-and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60-80 mg (28.7%), and 120-160 mg (2.1%). Patient characteristics were compared across doses using Cochran-Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). Results: Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16−2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15−5.83), 1.7-times higher with obesity (95% CI: 1.05−2.60), and 1.3 (95% CI: 1.01−1.78) and 1.8-times higher (95% CI: 1.17−2.86) with prior use of secondand first-generation antipsychotics, respectively. Conclusions: This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Adherence to lurasidone was comparable to or better than antipsychotic adherence reported in bipolar disorder literature.

Lurasidone in the Treatment of Bipolar Depression: Systematic Review of Systematic Reviews

“…In this regard, it is also worth noticing that the upcoming clinical trials should ideally investigate the impact of current and/or lifetime mixed features as primary outcomes. Similarly, greater attention and stratification of the reported results by upcoming RCTs should focus on psychotic features and (emerging) suicidality, which would on turn demand for extended longitudinal follow-up, including flexible-dose regimen arms, to better investigate medication adherence to lurasidone across varying dosing patterns [ 91 ]. This is particularly true considering that BD and mood disorders in general should be better evaluated from an extended longitudinal perspective, as originally postulated by Emil Kraepelin for “manic-depressive illness” [ 17 , 18 ].…”

Racial/ethnic differences in treatment quality among youth with primary care provider‐initiated versus mental health specialist‐initiated care for major depressive disorders

“…Patients were excluded if they did not have continuous Medicaid eligibility during the 6‐month period prior to the index MDD diagnosis and the 4‐month period since the treatment initiation (index treatment); if they received any MDD treatment during the 6‐month period prior to the index MDD diagnosis (Burger et al, ; Chen et al, ; Sajatovic et al, ); if they ever received a bipolar disorder diagnosis (ICD‐9‐CM: 296.0, 296.1, 296.4–296.8, 301.11); or if patients’ index diagnosis was given by a provider with missing or unknown specialty. Moreover, MDD cases identified by providers other than PCPs, psychiatrists, or social workers/psychologists (e.g., dermatologist and neurologist), or those identified in a hospital or emergency room were also excluded in order to focus the analysis on providers who were routinely providing mental health services to children.…”

Switching and augmentation strategies for antipsychotic medications in acute-phase schizophrenia: latest evidence and place in therapy

“…Also, the efficacy of high-dose risperidone was not observed in early nonresponders to 6 mg/day, the upper limit of the ordinary dose. 22 Sajatovic and colleagues 26 reported that a real-world analysis of 1114 bipolar patients indicated that 40 or 80 mg/day were the most common starting doses of lurasidone and 55.2 mg/day was the mean maintenance dose, and that higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Thus, an increase in a dosage within the ordinary range may be necessary unless efficacy is not shown, but trying high doses above the ordinary range is not recommended before switching from an antipsychotic to another one.…”