Real-world adherence assessment of lurasidone and other oral atypical antipsychotics among patients with schizophrenia: an administrative claims analysis

Rajagopalan, Krithika; Wade, Sally; Meyer, Nicole; Loebel, Antony

doi:10.1080/03007995.2017.1284656

Cited by 13 publications

(25 citation statements)

References 34 publications

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“…When a PDC of 80% or higher was used, adherence was reported to be below 50% (range 9.0-33.2%) in 11 of 12 studies with 6-12 months of follow-up [34,42,[44][45][46][47][48][49][50][51][52] (Table 2). These findings were consistent with adherence rates assessed by MPRs of 80% or higher (Table 2), with oral antipsychotic adherence of less than 50% in 5 of 7 studies over 6-12 months of follow-up [29,45,53,54], and by MPRs of 70% or higher [19,80,81]; for reporting an 18-month time point or only baseline adherence [38,56,77]; for not reporting a time period [76]; and for reporting mean PDC or MPR values only [32,37,65,66] Studies were excluded for reporting binary data without a time period [25,56,57]; median values [18,46,57,59,86]; data in person years [21]; or a 15-year time period [55] [20], with adherence ranges of 22.0-45.1%. Patient adherence rates for individual oral antipsychotics were not extensively characterized in the literature reviewed.…”

Section: Direct Costs Associated With Oral Antipsychotic Treatment Ad...supporting

confidence: 84%

“…In these studies, 9.4-50.9% of patients in the study population took olanzapine [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], 11.5-30.7% took quetiapine [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], 2.0-40.0% took risperidone [18-21, 23, 24, 26-34], 4.0-21.5% took aripiprazole [18-21, 23, 24, 26-32, 35], and 0-7% took clozapine [20, 24-26, 31, 36]. In realworld studies published prior to 2006, olanzapine was the administered treatment for an estimated 16.0-50.9% [18,21,25,27,30,32,33] of patients making up the study population; however, this range dropped to below 20% after 2006 (9.4-17.4%) [20,23,24,26,28,29,…”

Section: Direct Costs Associated With Oral Antipsychotic Treatmentmentioning

confidence: 99%

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Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States

et al. 2022

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Background: Schizophrenia is a chronic mental disorder associated with substantial morbidity and mortality affecting 0.25-1.6% of adults in the USA. Antipsychotic treatment is the standard of care for schizophrenia, but real-world treatment patterns and associated costs have not been systematically reviewed. Objective: We conducted a systematic review to summarize treatment patterns and associated costs related to oral antipsychotic treatment of patients with schizophrenia in the USA. Data Sources: We searched Medline (via PubMed) and Embase to identify relevant observational studies published from January 1, 2008, to June 1, 2018; costs were converted to 2018 US dollars.Study Eligibility: Observational, real-world studies reporting on patterns of treatment and/ or associated costs for adult patients with schizophrenia treated with oral antipsychotics in the USA were included. Results: Eighty-one studies were identified. Frequently prescribed oral second-generation antipsychotics were olanzapine (up to 50.9%), risperidone (up to 40.0%), and quetiapine (up to 30.7%). Suboptimal adherence was common across studies. Antipsychotic switching occurred in about half of patients, while antipsychotic combination therapy occurred in nearly 30%; all were associated with increased medication-related costs.

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Section: Direct Costs Associated With Oral Antipsychotic Treatment Ad...supporting

confidence: 84%

Section: Direct Costs Associated With Oral Antipsychotic Treatmentmentioning

confidence: 99%

Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States

et al. 2022

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“…The longer the treatment, the greater the chance of insufficient adherence. Data from administrative claims in the US suggest that, in clinical practice, patients with psychosis treated in an outpatient setting fill their prescriptions an average of 40‐60% of the days prescribed. Adherence studies find that poor mid‐term adherence ranges from 11.6% based on self‐report to 58.4% in studies using serum concentration.…”

Section: Efficacy Effectiveness and Tolerabilitymentioning

confidence: 96%

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

2018

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The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.

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“…8 So far, there has been limited exploration of how lurasidone fares in clinical practice. One study has reported lower rates of discontinuation with lurasidone compared with other SGAs when measuring health insurance administrative claims, 9 but was unable to determine predictors of treatment continuation.…”

Section: Introductionmentioning

confidence: 99%

A prospective year-long follow-up of lurasidone use in clinical practice: factors predicting treatment persistence

Osborne

Mace

Taylor

2018

Therapeutic Advances in Psychopharmacology

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Background:Our aim was to follow up patients prescribed lurasidone over 1 year to determine factors predicting treatment persistence.Methods:We used noninterventional, observational, prospective follow up of patients consecutively prescribed lurasidone in a large inner-city NHS mental health trust. We also performed retrospective analysis of outcomes from patient case notes.Results:Data were available for 69 patients consecutively prescribed lurasidone, of whom three (4%) were lost to follow up. Out of the 66 patients not lost to follow-up, 21 (32%) remained on lurasidone at 1 year. The main reasons for discontinuation were perceived ineffectiveness (49% of discontinuers) and adverse effects (36% of discontinuers), whilst a further seven refused all treatment. Median treatment time on lurasidone was 154 days (95% confidence interval (CI), 33–275). Patients who were not treatment-resistant had a substantially reduced risk of discontinuation, relative risk (RR) 0.18 [95% CI 0.08, 0.41, p < 0.001]. Medium doses (>37–74 mg) of lurasidone reduced the risk of discontinuation by 75% [RR 0.25 (95% CI 0.11, 0.58, p = 0.001)]; high doses (>74–148 mg) reduced the risk of discontinuation by 86% [RR 0.14 (95% CI 0.06, 0.35, p < 0.001)]. Risk of discontinuation was approximately doubled when the reason for prescribing lurasidone was poor tolerability of prior treatment [RR 2.01 (95% CI 1.05, 3.85, p = 0.035)].Conclusion:The likelihood of treatment continuation with lurasidone can be vastly improved by targeting individuals most likely to benefit and by using optimal doses.

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Real-world adherence assessment of lurasidone and other oral atypical antipsychotics among patients with schizophrenia: an administrative claims analysis

Cited by 13 publications

References 34 publications

Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States

Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

A prospective year-long follow-up of lurasidone use in clinical practice: factors predicting treatment persistence

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