Psychiatrists’ Judgments About Antipsychotic Benefit and Risk Outcomes and Formulation in Schizophrenia Treatment

Abstract

Psychiatrists favored treatments that primarily improve positive symptoms. Choice of formulation became more important as likely adherence declined.

Patients’ Preferences Related to Benefits, Risks, and Formulations of Schizophrenia Treatment

“…The findings of this study were similar to those of other published studies in which respondents valued improvements in social functioning and positive symptoms more than improvement in negative symptoms and avoidance of side effects (8,9). A related study in which the authors assessed psychiatrist judgments about medications' benefits and risks showed that the psychiatrists and patients had several results in common (21,22). Like patients, psychiatrists showed that positive symptoms were their dominant concern.…”

“…This survey was developed in conjunction with a similar instrument targeted to physicians (21,22). Applying an approach based in multicriteria decision analysis and the Benefit-Risk Action Team (BRAT) framework (23,24), we conducted written and telephone interviews with expert academic psychiatrists and assessed product inserts and publications to determine what attributes to include in the survey.…”

Physician and patient benefit–risk preferences from two randomized long-acting injectable antipsychotic trials

“…Detailed descriptions of the two trials have been published 20,21. These surveys were adapted from versions used in pilot studies conducted with patients and physicians sampled from online panels 18,19…”

“…Previous preference studies in schizophrenia, performed with online panels of psychiatrists and patients, demonstrated that schizophrenia patients were capable of completing such surveys,16,17 and that both physicians and patients place greater importance on improvements in positive symptoms than on improvements in negative symptoms or in avoiding treatment-related AEs (weight gain, extrapyramidal symptoms [EPS], hyperglycemia, and hyperprolactinemia) 18,19. Patient adherence to oral antipsychotics was identified as an important factor in the assessment of oral versus injectable medicine formulations 20–22.…”

“…Patient adherence to oral antipsychotics was identified as an important factor in the assessment of oral versus injectable medicine formulations 20–22. For example, in pilot studies using online panels of patients and physicians, respondents preferred long-acting injectables (LAIs) over daily oral antipsychotics for hypothetical patients with past nonadherence to antipsychotics, though patients preferred the oral formulation for patients with high prior adherence 18,19. An important open question is whether the results of these pilot studies are reproducible in different samples, and particularly, whether the online panel results accurately reflect the preferences of schizophrenia patients who meet the clinical trial inclusion/exclusion criteria 18,19…”