The effect of long-acting paliperidone palmitate once-monthly on negative and depressive symptoms in patients with schizophrenia switched from previous unsuccessful treatment with oral aripiprazole

Abstract

Background:The negative symptoms of schizophrenia are generally harder to recognize, more difficult to treat than positive symptoms, and have a significant impact on patient functioning and overall outcomes. Treatment with aripiprazole may be associated with benefits on negative symptoms and functioning given its partial agonism to the dopamine D 2 receptor. The aim of this subanalysis was to explore the impact of flexibly dosed, long-acting paliperidone palmitate once monthly (PP1M) on negative and depressive symptoms, disorganized thoughts, anxiety, extrapyramidal symptoms, and patient functioning in nonacute adult patients with schizophrenia previously unsuccessfully treated with oral aripiprazole monotherapy. Methods: Post-hoc subanalysis of 46 nonacute but symptomatic patients enrolled in a prospective, interventional, single-arm, multicenter, open-label 6-month study. Results: At endpoint, improvements of ⩾ 20% and ⩾ 50% in the Positive and Negative Syndrome Scale (PANSS) total score were observed in 52.2% and 21.7% of patients, respectively. Significant and clinically relevant improvements were observed at endpoint in mean (standard deviation [SD]) PANSS negative subscale score (−3.0 (5.0); p < 0.0001) and in the PANSS Marder factor scores for negative symptoms (−2.9 (5.4); p = 0.0006), disorganized thoughts (−2.8 (4.3); p < 0.0001) and anxiety/depression (−1.8 (3.9); p = 0.0031). Patient functioning assessed by mean (SD) Personal and Social Performance scale score (3.9 (13.2); p = 0.0409), Mini International Classification of Functioning rating for Activity and Participation Disorders in Psychological Illnesses total scores (−2.9 (7.1); p = 0.0079), and Extrapyramidal Symptom Rating Scale scores (−0.6 (3.4); p = 0.0456) improved significantly at endpoint. PP1M was well tolerated with no new safety signals. Conclusions: Six-month treatment with flexibly dosed PP1M was associated with significant and clinically relevant improvements in negative and depressive symptoms, disorganized thoughts, functioning, and extrapyramidal symptoms in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral aripiprazole.

Effects on Satisfaction and Service Engagement of Paliperidone Palmitate Compared with Oral Paliperidone in Patients with Schizophrenia: An Open Label Randomized Controlled Trial

“…Previous investigations reported the superior efficacy of LAIs on negative symptoms, also in samples where they are a predominant component of psychopathology (39,(59)(60)(61)(62). Some studies also confirmed our finding of superior PP1M effects on negative symptoms in nonacute patients who did not respond to oral antipsychotic (50,63). A possible explanation of this result is that patients who suffer from negative symptoms become apathetic and lose willingness and ability to adhere to prescriptions.…”

<p>Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia</p>

“…In acutely ill patients with schizophrenia and predominantly negative symptoms, paliperidone ER significantly improved negative symptoms when compared with placebo 101. Clinically relevant improvements in negative, depressive, and anxiety symptoms and disorganized thoughts have also been observed in patients with schizophrenia treated with PP1M in a real-world setting 102. Sustained improvements in positive and negative subscale and symptoms factor scores indicate the efficacy of PP3M across the spectrum of schizophrenia comprising major domains.…”

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

“…Studies have revealed that paliperidone is effective in the treatment of schizoaffective disorder [ 49 , 50 ]. The once-monthly PLAI used to treat patients with acute exacerbation of schizoaffective disorder alleviated psychotic symptoms and manic and depressive symptoms [ 49 ].…”