Initiation of atypical antipsychotic agents and health outcomes in patients with schizophrenia

Ren, Xinhua S.; Lee, A. F.; Huang, Yuhui; Hamed, Alaa; Herz, Lawrence; Miller, Donald R.; Kazis, Lewis E.

doi:10.1111/j.1365-2710.2004.00592.x

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In the United States, olanzapine initiators were found to have more complex psychiatric histories than risperidone initiators including more pre-existing psychiatric comorbidities [20], more prior use of other classes of psychiatric medications [20,21], higher prior psychiatric inpatient costs [22], more previous treatment with clozapine [21,23,24], and more initial prescriptions from psychiatrists [24]. Consistent with these prior studies, olanzapine initiators in the current analysis were more likely to have diagnoses for manic episodes and had more prior antidepressant use.…”

Section: Discussionsupporting

confidence: 78%

“…Consistent with these prior studies, olanzapine initiators in the current analysis were more likely to have diagnoses for manic episodes and had more prior antidepressant use. In the United States, risperidone was found to be initiated more often than olanzapine for patients with schizophrenia who have more physical comorbidities [20,[22][23][24][25]. Consistent with these studies, the univariate analysis found that risperidone initiators were more likely to have previous claims for diabetes mellitus.…”

Section: Discussionmentioning

confidence: 53%

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Characteristics of Outpatients Initiated on Olanzapine versus Risperidone in the Treatment of Schizophrenia in Japan: A Healthcare Database Analysis

Nakahara

Takahashi

et al. 2011

CNPT

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Purpose:To compare the characteristics of outpatients who were initiated on olanzapine or risperidone in the naturalistic treatment of schizophrenia in Japan. Methods: The Japan Medical Data Centre Database (JMDC) was used to identify patients diagnosed with schizophrenia or schizoaffective disorder using ICD-10 codes. Patients were required to be 20-65 years old, to have initiated olanzapine or risperidone therapy at an outpatient setting between January 2004 and July 2008, and to be continuously enrolled during the 6 months prior and 12 months post initiation date. Treatment groups were compared on demographics, medical and psychiatric comorbidities, prior medication use patterns, and prior health care resource utilization. Chi-square tests and t-tests were employed for univariate comparisons. Multivariate logistic regressions were used to assess the independent contribution of the predictors. Results: In both the multivariate and univariate models, olanzapine-initiated patients (n=334) were more likely than risperidone-initiated patients (n=502) to have a history of treatment with antidepressants (56.6% vs. 43.8%, p < 0.001) and a history of prior manic episodes (59.3% vs. 51.6%, p = 0.03). Discussion: Current findings suggest that in Japan, olanzapine and risperidone are not used interchangeably. Olanzapine appears to be used more often for schizophrenia patients with comorbid mood symptoms, as reflected by a prior diagnosis of manic episodes and prior treatment with antidepressants. Previous research has found that schizophrenia patients with depressive symptoms have a worse prognosis across a broad range of outcomes including the use of more relapse-related mental health services, higher rates of arrests, and suicidality, as well as poorer quality of life, mental functioning, family relationships, and medication adherence.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 53%

Characteristics of Outpatients Initiated on Olanzapine versus Risperidone in the Treatment of Schizophrenia in Japan: A Healthcare Database Analysis

Nakahara

Takahashi

et al. 2011

CNPT

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“…Since poor treatment persistence contributed to an estimated 40% relapses (Weiden and Zygmund 1997), levels of treatment persistence have become an increasingly important factor in prescription choices by physicians of different antipsychotic agents. However, considering the inappropriateness of the conventional approach in measuring treatment persistence as well as the limitations of the present study, more research is needed to examine the extent to which adjunctive use of other agents, a common practice among patients with schizophrenia (Ren et al 2004), will influence levels of treatment persistence. Future research should also assess the impact of poor treatment persistence on a wide spectrum of patient outcomes (Ren et al 2005b).…”

Section: Discussionmentioning

confidence: 99%

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Ren¹,

Qian²,

Kazis³

2007

Neuropsychiatric Disease and Treatment

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Prior studies have demonstrated the importance of treatment persistence with antipsychotic agents in sustaining control of schizophrenic symptoms. However, the conventional approach in measuring treatment persistence tended to use only the fi rst prescription episode even though some patients received multiple prescriptions (or multiple treatment episodes) of the same medication within one year following the initiation of the index drug. In this study, we used data from the Veterans Health Administration in the United States to assess the extent to which patients received multiple prescriptions. The study found that about a quarter of the patients had two or more treatment episodes and that levels of treatment persistence tended to vary across treatment episodes. Based on these results, we offered an alternative approach in which we calculated treatment persistence with typical and atypical antipsychotic agents separately for patients with one, two, or three treatment episodes. Considering that patients with different number of treatment episodes might differ in disease profi les, this treatment episode-specifi c approach offered a fair comparison of the levels of treatment persistence across patients with different number of treatment episodes. Future research needs to extend the analyses beyond two antipsychotic classes to individual antipsychotic agents. A more comprehensive assessment using appropriate analytic methods should help physicians make prescription choices that will ultimately improve the care of patients with schizophrenia.

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“…In other medication studies involving patients diagnosed with schizophrenia and their anti-psychotic use, Ren et al [2002bRen et al [ , 2004Ren et al [ , 2005b merged patientreported HRQoL data (VR-36) and utilization of psychiatric services with medication history that includes dosage and duration of use on the basis of 89,107 subjects. Using a cohort design, results show that olzanzapine and risperidone users were associated with different sociodemographic characteristics; those on olanzapine compared to those on risperidone were younger (Po0.001), Hispanic (Po0.001), with fewer medical co-morbidities and a lower body mass index (Po0.05).…”

Section: Utilization Of Services and Medication Therapymentioning

confidence: 99%

Medication effectiveness studies in the United States Veterans Administration health care system: a model for large integrated delivery systems

Kazis

Nethercot

Ren

et al. 2006

Drug Development Research

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The Veterans Administration health care system (VA) is one of the largest integrated delivery systems in the United States. The VA provides a rich central data base repository that includes detailed medication data, historical information about patient morbidities, clinical data, and inpatient and outpatient utilization information from claims data and health status information derived directly from the patient. The Veterans Health Study (VHS), a large-scale prospective study following patient's health outcomes for up to six years, derived and validated a number of patient questionnaires for wide-scale use in the VA as part of its quality monitoring and research programs. Chief among these assessments are the Veterans Rand 36 item and 12 item health surveys (VR-36 and VR-12); other assessments include measures of illness and their associated severity, health-related quality of life, and utilization of health care services. This report reviews the methodologies developed in the VHS and their subsequent applications in the VA system for conducting medication effectiveness studies based upon non-randomized prospective quasiexperimental designs that approximate real world clinical conditions. Study cohorts are described that link the patient questionnaire data with administrative, clinical, and pharmacy data to address questions about medication effectiveness. Statistical models include comprehensive risk adjustments in order to better understand the association between medications that are being compared and their associated patient outcomes. Applications of this approach are presented for medication studies in those diagnosed with hypertension, osteoarthritis, low back pain, depression, and schizophrenia. Future implications of this work are described for purposes of quality improvement. Drug Dev. Res. 67:217-226, 2006. r

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Initiation of atypical antipsychotic agents and health outcomes in patients with schizophrenia

Cited by 7 publications

References 19 publications

Characteristics of Outpatients Initiated on Olanzapine versus Risperidone in the Treatment of Schizophrenia in Japan: A Healthcare Database Analysis

Characteristics of Outpatients Initiated on Olanzapine versus Risperidone in the Treatment of Schizophrenia in Japan: A Healthcare Database Analysis

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Medication effectiveness studies in the United States Veterans Administration health care system: a model for large integrated delivery systems

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