Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia

MacEwan, Joanna P.; Forma, Felicia; Shafrin, Jason; Hatch, Ainslie; Lakdawalla, Darius N.; Lindenmayer, Jean-Pierre

doi:10.18553/jmcp.2016.22.11.1349

Cited by 36 publications

(71 citation statements)

References 45 publications

(36 reference statements)

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“…While efficacy may be similar for patients with and without co-occurring substance-related disorders, when differences in treatment duration have been taken into account, substance use consistently predicts poorer adherence and higher rates of discontinuation [4][5][6]. In a recent pooled analysis of two randomized trials (total n = 1154), substance use was associated with reduced adherence which sequentially predicted earlier discontinuation [23].…”

Section: Future Science Groupmentioning

confidence: 99%

“…Patients with schizophrenia often experience poor clinical outcomes, with a recent cohort study by Crump et al demonstrating that patients with schizophrenia die 12-15 years earlier as compared with the general population [3]. Comorbid substance-related disorders have been shown to be powerful drivers of poorer clinical outcomes, including nonadherence to medication [4][5][6], disease relapse [7,8] and mortality [9] among patients with schizophrenia, making this a particularly vulnerable and challenging-to-treat subpopulation. The impacts of substance use on disease management, specifically on adherence and relapse, are complex and hypothesized to result from both the impacts of active substance use on cognition and judgment and from the direct psychotogenic effects of some substances (e.g., cannabis) [10].…”

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confidence: 99%

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Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits

et al. 2018

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Aim: Compare medication utilization, costs and healthcare resource use in schizophrenia patients with substance-related disorders initiated on once-monthly paliperidone palmitate (PP1M) or an oral atypical antipsychotic (OAA). Materials & methods: Data from six Medicaid states (07/2009-03/2015) were used to compare outcomes between PP1M and OAA patients. Results: PP1M patients had higher 12-month antipsychotic adherence and persistence than OAA patients. PP1M patients had lower medical (mean monthly cost difference [MMCD] = US$-191, p = 0.020), higher pharmacy (MMCD = US$250, p < 0.001) and similar total costs (MMCD = US$59, p = 0.517) during the overall follow-up. PP1M patients had lower rates of outpatient visits and inpatient days but higher rates of mental health-related utilization. Conclusion: PP1M was associated with higher antipsychotic adherence and persistence, and similar total costs versus OAA.

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Section: Future Science Groupmentioning

confidence: 99%

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confidence: 99%

Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits

et al. 2018

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“…Up to two-thirds of commercially insured patients with schizophrenia in the United States (US) were found to have inadequate adherence to their AP medications [5,6]. Nonadherence hinders treatment success and can lead to poor outcomes and high risks of relapse and rehospitalization [7][8][9][10][11]. Nonadherence is also associated with increased healthcare resource utilization (HRU) and costs [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

Patel

Émond

Lafeuille

et al. 2019

Drugs - Real World Outcomes

176

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Purpose Reducing the dosing frequency of antipsychotics (APs) with long-acting injectables (LAIs) such as once-monthly paliperidone palmitate (PP1M) can improve adherence and clinical outcomes for schizophrenia patients. This US study compared physical and psychiatric comorbidity-related outcomes, AP adherence, healthcare resource utilization (HRU), and costs pre-and post-transition to PP1M among schizophrenia patients treated with oral risperidone/paliperidone pre-PP1M transition. Methods Health insurance claims from the IQVIA™ PharMetrics Plus database (01/01/2012-07/31/2018) were used to identify adults with ≥ 2 schizophrenia diagnoses, ≥ 1 claim for PP1M, and ≥ 30 days of treatment with oral risperidone/ paliperidone in the 60 days before the first PP1M claim (i.e., the index date). Comorbidity-related outcomes, adherence to APs (measured via the proportion of days covered [PDC]), all-cause per-patient-per-month (PPPM) HRU, and all-cause PPPM medical, pharmacy, and total costs (i.e., sum of medical and pharmacy costs) during the 6-month periods pre-and post-transition to PP1M were compared using generalized estimating equation models adjusted for repeated measurements. Analyses were replicated in the subset of patients with ≥ 1 all-cause inpatient stay pre-PP1M transition. Findings Among 427 schizophrenia patients transitioning from oral risperidone/paliperidone to PP1M, the mean age was 41.1 years and 37.9% were female. Following the PP1M transition, patients were less likely to have claims with a diagnosis for psychoses (odds ratio [OR] 0.41; P < 0.001), hypertension (OR 0.80; P = 0.011), depression (OR 0.70; P < 0.001), drug abuse (OR 0.60; P < 0.001), substance-related and addictive disorders (OR 0.73; P = 0.003), bipolar and related disorders (OR 0.59; P < 0.001), sleep-wake disorders (OR 0.68; P = 0.017), anxiety disorders (OR 0.78; P = 0.034), and other conditions that may require a focus of clinical attention (OR 0.58; P < 0.001). Mean PDC by APs was higher post-PP1M (mean = 0.81) versus pre-PP1M (mean = 0.68) transition. Post-PP1M, patients were less likely to have an all-cause emergency room visit (OR 0.51; P < 0.001) or inpatient stay (OR 0.39; P < 0.001) compared to pre-PP1M. All-cause total healthcare costs remained similar post-versus pre-transition to PP1M (mean monthly cost difference [MMCD] = $228; P = 0.260). Pharmacy costs increased post-PP1M (MMCD = $960; P < 0.001), but were offset by decreasing medical costs (MMCD = − $732; P < 0.001), largely driven by lower costs related to inpatient stays (MMCD = − $695; P < 0.001) and emergency room visits (MMCD = − $63; P < 0.001). For patients with ≥ 1 all-cause inpatient stay pre-PP1M transition (N = 177), a more pronounced improvement in comorbidity-related outcomes, a more pronounced reduction in HRU, and a reduction in total healthcare costs (MMCD = − $1308; P < 0.001) were observed post-transition to PP1M. Implications Among schizophrenia patients in the US, transitioning to PP1M following oral risperidone/paliperidone treatment was associated...

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“…GBTM has been used in multiple disciplines, including public health and medical sciences [21,26,27]. The PROC TRAJ procedure, part of an SAS add-in module, was used to analyze the NPS trajectories of the subjects.…”

Section: Discussionmentioning

confidence: 99%

The Trajectories of the Number of Pain Sites and Their Associated Factors in Older Adults: Results from the Korean Longitudinal Study of Ageing

2018

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Background: The aging of the population will result in an increase in demand for pain management. Pain adversely affects physical and mental functioning in older adults and accounts for a considerable proportion of all medical expenses. Objectives: This study was performed to investigate the patterns of changes in the trajectories of the number of pain sites in older adults and the factors that affect these patterns according to gender. Methods: Data were extracted for subjects that participated in the Korean Longitudinal Study of Ageing from 2006 to 2014. The study population consisted of 2,839 individuals (1,190 men and 1,649 women) ≥60 years old. A group-based trajectory model was used to determine the optimal number of subgroups and the trajectories of the number of pain sites according to gender. A multinomial regression analysis was conducted to identify factors that affect the probability of inclusion in each trajectory group. Results: The trajectories of the number of pain sites were consistent in both genders. Almost all women had one or more pain symptom, and a greater number of pain sites than men. Older age, longest-duration occupation requiring manual labor, lack of physical activity, depressive symptoms, and poor self-rated health were associated with a greater number of pain sites in both genders. A lower level of education, married status, and experience of injury were associated with the number of pain sites in men but not in women, while household income and chronic diseases were associated with the number of pain sites only in women. Conclusions: The pain status at the early stage is predictive of future pain. In this study, we identified gender differences in the trends of the number of pain sites and associated factors. Further comprehensive studies on pain intensity and duration are required.

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Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia

Cited by 36 publications

References 45 publications

Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits

Real-world adherence and economic outcomes associated with paliperidone palmitate versus oral atypical antipsychotics in schizophrenia patients with substance-related disorders using Medicaid benefits

Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

The Trajectories of the Number of Pain Sites and Their Associated Factors in Older Adults: Results from the Korean Longitudinal Study of Ageing

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