Real-world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications

Abstract

Introduction: Antipsychotics are widely prescribed for patients with schizophrenia. The Brazilian public health system provides these patients free of charge to patients and it is pertinent to evaluate their benefits. Objective: To evaluate the effectiveness of olanzapine and risperidone in the treatment of patients with schizophrenia in the real world and assessing risk factors for their discontinuation through a national non-concurrent cohort with 16 years of followup. Methods: Three SUS administrative databases were integrated by deterministicprobabilistic linkage. After, patients were matched (1:1) for psychiatric hospitalization, year of receiving the antipsychotic, sex and age, considering either olanzapine or risperidone at study entry. Kaplan-Meier was used to estimate the cumulative probabilities of discontinuation of treatment and associated factors were identified. Sensitivity analyzes were performed. Results: 3416 pairs of patients were included. Olanzapine had a longer time until discontinuation of treatment (p = 0.021), and risperidone had a higher risk of discontinuation (p = 0.021). Among patients persistent for at least 24 months, there was no statistically significant difference. Conclusion: Olanzapine demonstrated superior real-world effectiveness over risperidone, in terms of survival and psychiatric hospitalization. This superiority was not sustained in all analyzes.

Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders

“…Persistence, adherence, or failure to treatment, as well as the rate of SGAs discontinuation or risk of hospitalization, were analyzed in most studies [ 52 , 53 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 ]. Overall, olanzapine demonstrated superior real-world effectiveness vs. risperidone in relapse-free survival and psychiatric hospitalization [ 61 ].…”

Adoption of new therapies in the treatment of Hepatitis: a verification of the accuracy of budget impact analysis to guide investment decisions

“…A national cohort based on the population of patients undergoing chronic hepatitis C treatment was constructed from January 2000 to October 2015 using a deterministic-probabilistic linkage approach and using the data records contained in the following databases: Hospital Information System (SIH, Acronym in Portuguese), Outpatient Information System (SIA, acronym in Portuguese) and Mortality Information System (SIM, acronym in Portuguese). The deterministicprobabilistic linkage was assessed by linking data that presented a reliable unique identifier (deterministic), and for the others by weighing the identifiers, second degree of certainty and (probabilistic) precision of the pairing [59][60][61][62][63][64][65]. The probability failure for this technique varies from 2 to 5% of the total data [66], which does not compromise the validity or quality of this study.…”

Budget impact analysis of medicines: estimated values versus real-world evidence and the implications

“…This technique enabled the integration of the following databases of the Brazilian public health system: Hospital Information System (SIH), Outpatient Information System (SIA), and Mortality Information System (SIM). The deterministic-probabilistic relationship was undertaken by linking data with a reliable, unique identifier (deterministic), and others by weighting the identifiers according to the degree of pairing certainty and precision (probabilistic) [69][70][71][72][73][74][75]. The possibility of a lack of success with this technique is 2% to 5% of the total data, which does not compromise the validity or quality of this study.…”