The Impact of Antipsychotic Formulations on Time to Medication Discontinuation in Patients with Schizophrenia: A Dutch Registry-Based Retrospective Cohort Study

Abstract

Background Many patients with schizophrenia discontinue antipsychotic medication, frequently with adverse outcomes. Although different antipsychotic formulations are associated with different times to discontinuation, not much is known about discontinuation rates with oral-weekly formulations. Such a formulation of penfluridol is available in both the Netherlands and several other countries. Objectives We aimed to investigate the impact of antipsychotic formulations on time to discontinuation, especially the oral-weekly formulation. Methods In a large, registry-based, retrospective cohort study from 1 January 2013 to 31 December 2016, we determined the time to medication discontinuation during the follow-up period with antipsychotic formulations, including oral-daily, oral-weekly, depot, or a combination of these. Patients with schizophrenia aged between 18 and 69 years were included and stratified according to the duration of recent antipsychotic use (taking the same formulation for ≤ 60 days or > 60 days before follow-up: short-term or long-term recent antipsychotic use). Medication discontinuation was defined as discontinuation of current antipsychotic formulation. Results Overall, 8257 patients were included for analyses, with 80% of patients discontinuing antipsychotic medication. Time to discontinuation was longer in those with long-term recent antipsychotic use before the follow-up period and longest for oral-daily formulations. Patterns for discontinuation of oral-weekly and depot formulations were similar, regardless of the duration of recent antipsychotic use before follow-up. More prior discontinuations were associated with shorter time to discontinuation. Conclusions Time to discontinuation differed considerably between formulations. The duration of recent antipsychotic use was a strong predictor of time to discontinuation. While oral-daily formulations had the longest time to discontinuation in the long-term recent antipsychotic use group, discontinuation trends were similar for oral-weekly and depot formulations. An oral-weekly formulation, whose administration route is noninvasive, might therefore be considered an alternative to depot formulations. Arnold P. M. van der Lee and Ibrahim Önsesveren contributed equally to this work.

Identifying longitudinal medication adherence patterns of antipsychotic treatments: A real‐world cohort study in Catalonia, Spain

“…Future research could specifically investigate the adherence trajectories of these patients and explore the potential positive effect of LAI on adherence, [12][13][14]54,56 including the effect on adherence of switching from oral to LAI antipsychotics. In addition to exploring clinical outcomes, the economic burden of treatment and health service use associated to each trajectory needs to also be addressed to better inform decision-making.…”

“…They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations. [12][13][14] However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive. 15 Antipsychotic polypharmacy, defined as the concurrent treatment with two or more antipsychotics, 16,17 tends to lead to more complex regimens, which may adversely affect medication adherence.…”

“…Formulations such as long‐acting injectables (LAI) require administration in less frequent intervals. They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations 12–14 . However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive 15 .…”

Identifying longitudinal medication adherence patterns of antipsychotic treatments: A real‐world cohort study in Catalonia, Spain

“…Future research could specifically investigate the adherence trajectories of these patients and explore the potential positive effect of LAI on adherence, [12][13][14]54,56 including the effect on adherence of switching from oral to LAI antipsychotics. In addition to exploring clinical outcomes, the economic burden of treatment and health service use associated to each trajectory needs to also be addressed to better inform decision-making.…”

“…They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations. [12][13][14] However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive. 15 Antipsychotic polypharmacy, defined as the concurrent treatment with two or more antipsychotics, 16,17 tends to lead to more complex regimens, which may adversely affect medication adherence.…”

“…Formulations such as long‐acting injectables (LAI) require administration in less frequent intervals. They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations 12–14 . However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive 15 .…”

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

“…Most other studies on RP-UI are based on a single center or even a single surgeon. Patients insured by Zilveren Kruis are representative of the entire Dutch population [35] , so the current results can be extrapolated to the total Dutch population.…”

Identifying longitudinal medication adherence patterns of antipsychotic treatments: A real‐world cohort study in Catalonia, Spain

“…Future research could specifically investigate the adherence trajectories of these patients and explore the potential positive effect of LAI on adherence, [12][13][14]54,56 including the effect on adherence of switching from oral to LAI antipsychotics. In addition to exploring clinical outcomes, the economic burden of treatment and health service use associated to each trajectory needs to also be addressed to better inform decision-making.…”

“…They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations. [12][13][14] However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive. 15 Antipsychotic polypharmacy, defined as the concurrent treatment with two or more antipsychotics, 16,17 tends to lead to more complex regimens, which may adversely affect medication adherence.…”

“…Formulations such as long‐acting injectables (LAI) require administration in less frequent intervals. They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations 12–14 . However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive 15 .…”

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

“…Most other studies on RP-UI are based on a single center or even a single surgeon. Patients insured by Zilveren Kruis are representative of the entire Dutch population [35] , so the current results can be extrapolated to the total Dutch population.…”

Identifying longitudinal medication adherence patterns of antipsychotic treatments: A real‐world cohort study in Catalonia, Spain

“…Future research could specifically investigate the adherence trajectories of these patients and explore the potential positive effect of LAI on adherence, [12][13][14]54,56 including the effect on adherence of switching from oral to LAI antipsychotics. In addition to exploring clinical outcomes, the economic burden of treatment and health service use associated to each trajectory needs to also be addressed to better inform decision-making.…”

“…They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations. [12][13][14] However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive. 15 Antipsychotic polypharmacy, defined as the concurrent treatment with two or more antipsychotics, 16,17 tends to lead to more complex regimens, which may adversely affect medication adherence.…”

“…Formulations such as long‐acting injectables (LAI) require administration in less frequent intervals. They are considered an effective strategy to improve medication adherence, particularly beneficial for patients with a previous history of suboptimal adherence to oral formulations 12–14 . However, its use may be limited by budgetary constraints in determined clinical settings, as LAI medication is considerably more expensive 15 .…”

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

“…Most other studies on RP-UI are based on a single center or even a single surgeon. Patients insured by Zilveren Kruis are representative of the entire Dutch population [35] , so the current results can be extrapolated to the total Dutch population.…”