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

Abstract

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...

The Impact of Once-Monthly Paliperidone Palmitate on Healthcare Utilization Among Patients With Schizophrenia Treated in an Integrated Healthcare System: A Retrospective Mirror-Image Study

“…As expected and consistent with the previous studies [ 24 , 30 ], the mean number of outpatient visits increased significantly from pre to post PP1M initiation. PP1M treatment necessitates a physician outpatient visit each month as opposed to oral antipsychotic treatment in which routine visits are usually spaced every 3–6 months.…”

“…For example, in a previous study of Veteran Affairs patients transitioning from orally administered paliperidone/risperidone to PP1M, Patel et al found that the mean number of visits reduced for all-cause (2.3 to 1.5, p < 0.05), mental health-related (1.5 to 0.8, p < 0.05), and schizophrenia-related inpatient visits (0.6 to 0.3, p < 0.05) from 12 months before to 12 months after transitioning to PP1M. The mean length of stay also reduced for all-cause (28.1 to 14.0 days, p < 0.05), mental health-related (27.1 to 13.8 days, p < 0.05), and schizophrenia-related (13.2 to 5.7 days, p < 0.05) inpatient visits [ 30 ]. Other studies have compared HRU between patients on PP1M and those on oral antipsychotics and have reported reduced acute HRU in patients on PP1M compared to those on oral antipsychotics [ 23 – 28 ].…”

Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study

“…The once-monthly PLAI used to treat patients with acute exacerbation of schizoaffective disorder alleviated psychotic symptoms and manic and depressive symptoms [ 49 ]. Paliperidone has also been demonstrated to alleviate depressive symptoms in patients with schizophrenia [ 51 ]. In our study, the LAI group used fewer concomitant medications than did the NLAI group, including antidepressants, which suggests that PLAI can also treat depressive symptoms in patients with schizophrenia.…”

Defining “Adequately Treated”: A Post Hoc Analysis Examining Characteristics of Patients with Schizophrenia Successfully Transitioned from Once-Monthly Paliperidone Palmitate to Once-Every-3-Months Paliperidone Palmitate

“…Suboptimal levels of adherence and persistence with antipsychotic therapy are ongoing challenges in the treatment of schizophrenia. 1,2 As reported by the American Psychiatric Association, poor adherence is associated with poor outcomes, including increased risks of relapse, rehospitalization, suicidal and aggressive behaviors, and mortality. 2 Because of their long pharmacokinetic half-lives, longacting injectable (LAI) formulations of antipsychotic medications allow for less-frequent treatment administration and can reduce the treatment burden associated with having to remember to take a medication every day.…”