Oral and Palmitate Paliperidone Long-Acting Injectable Formulations’ Use in Schizophrenia Spectrum Disorders: A Retrospective Cohort Study from the First Episode Psychosis Intervention Program (CRUPEP)

Abstract

Background Long-acting injectable antipsychotics (LAIs) may be a suitable therapeutic option for those patients in earlier stages of psychosis to avoid relapses and disease progression. Despite that, there is a lack of evidence in the literature regarding the use of LAIs in this profile of patients. Methods This is a retrospective cohort analysis to assess the efficacy, tolerability, and pattern of use of palmitate paliperidone long-acting injectable (PPLAI) formulations (1- and 3-month doses) compared to oral paliperidone/risperidone in patients with a nonaffective first episode of psychosis (FEP) over 12 months of follow-up. Relevant sociodemographic and clinical information were assessed, as well as main clinical scales: Positive and Negative Syndrome Scale, Personal and Social Performance Scale, and Clinical Global Impression Scale Improvement and Severity measures. Results The study included 48 patients, 16 per arm, who were aged 20–50 years and had an FEP. Significant improvements were registered for all treatment groups. Despite that, patients receiving PPLAI 1- and 3-month formulations obtained greater improvements than those in the oral group in the main domains assessed (P < .001). We found no statistically significant differences in hospitalizations between groups. Side effects were presented in 24% of patients. A trend towards reducing antipsychotic doses was observed in 43.8% of patients to achieve the minimum effective dose and avoid the occurrence of side effects. Conclusions To our knowledge, this is the first study assessing the use of palmitate paliperidone long-acting formulations versus oral risperidone or paliperidone in FEP. Treatment with PPLAI formulations seems to be an effective therapeutic choice at earlier stages of the disease.

Cumulative Clinical Experience of the Use of Paliperidone Palmitate 3-Monthly Long-Acting Injection in the Treatment of Schizophrenia: A Critical Appraisal

“…Furthermore, a recent study evaluated the role of PP1M, PP3M versus oral paliperidone and risperidone in the first episode of psychosis. 57 Patients in the PP3M group achieved significant improvements compared to oral treatments in overall clinical symptom severity and saw a substantial improvement in the main domains of personal and social functioning after 1 year. Also this study demonstrated that patients treated with PP3M associated a lower concomitant use of benzodiazepines.…”

“…Also this study demonstrated that patients treated with PP3M associated a lower concomitant use of benzodiazepines. 57 …”

“…Also this study demonstrated that patients treated with PP3M associated a lower concomitant use of benzodiazepines. 57 In this regard, more recent evidence suggests that the use of LAIs and PP3M in particular may have a beneficial effect on the need for concomitant medication. For example, a large Spanish cohort of psychiatric patients demonstrated that benzodiazepine use was considerably lower for patients on long-acting compared to oral antipsychotics.…”