Treatment discontinuation of long-acting injectables or oral atypical antipsychotics among Medicaid recipients with schizophrenia

Abstract

Aims: Among patients with schizophrenia, poor adherence and persistence with oral atypical antipsychotics (OAA) often results in relapse and hospitalization. Second-generation antipsychotic long-acting injectables (SGA LAI) have demonstrated higher adherence than first-generation antipsychotic LAI and OAA therapies. This study aimed to determine whether SGA LAIs are associated with better persistency compared to OAA among Medicaid recipients with schizophrenia. ), patients aged 18 years with schizophrenia and 2 pharmacy claims more than 90 days apart for the same SGA LAI or OAA were selected. New users of the specific antipsychotic agent were classified, based on their index agent, as: OAA, paliperidone palmitate LAI (PPLAI), aripiprazole LAI (ALAI), and risperidone LAI (RLAI). Discontinuation during 1 year of follow-up was defined as a 60-day gap in the index OAA or SGA LAI medication past the exhaustion of the previous claim's supply. Inverse probability of treatment weights (IPTW) balanced the cohort characteristics, and weight outliers (<0.1 or >0.9) were excluded. IPTW-weighted Cox proportional hazards regression estimated hazard ratios for discontinuation. Results: Cohorts included 7,029 OAA, 4,302 PPLAI, 586 ALAI, and 1,456 RLAI patients. Mean age was 38.0-41.0 years and 44.0-46.6% were female. Persistence was significantly longer in the SGA LAI cohorts than in the OAA cohort. Adjusted hazard ratios (95% confidence intervals) for discontinuation were 0.60 (0.56-0.64) for PPLAI, 0.69 (0.60-0.79) for ALAI, and 0.70 (0.64-0.77) for RLAI vs OAA. Limitations: Results may not be generalizable to patients covered by commercial or Medicare insurance, and limitations inherent to any claims-based retrospective analysis apply. Conclusions: SGA LAI may be a valuable option for treating schizophrenia given the improvement in persistence. ARTICLE HISTORY

Treatment Persistence Between Long-Acting Injectable Versus Orally Administered Aripiprazole Among Patients with Schizophrenia in a Real-World Clinical Setting in Japan

“…In this claims data study, we found that patients who initiated AOM were, indeed, less likely to discontinue treatment compared with those who initiated OA in routine clinical practice in Japan (adjusted HR 0.54, 95% CI 0.43-0.68). Our findings are consistent with trends observed in other claims data studies showing that AOM users in the USA are less likely to discontinue treatment (HR 0.69, 95% CI 0.60-0.79) [15] and have significantly longer time to discontinuation than oral antipsychotic users [16]. Although our results showed the advantage of AOM in treatment continuation, there were some biases to be considered when interpreting the results of this study.…”

“…This also paralleled the trend of better adherence with risperidone LAI compared with orally administered risperidone [12]. Our results would also add to the benefits of LAIs compared with oral antipsychotics in terms of a longer treatment duration, previously reported for paliperidone, risperidone, and haloperidol [7,14,15]. Now that the advantages of LAIs over oral antipsychotics in treatment persistence seem to be evident, the next research topic may be a comparison among LAIs.…”

“…LAIs have at least similar treatment outcomes (e.g., relapse prevention) to oral antipsychotics [8,9], with some studies reporting superiority of LAIs over oral treatments [10][11][12]. In addition, patients who initiated LAIs were reportedly more adherent and had longer time to treatment discontinuation than those receiving oral antipsychotics in several non-randomized studies [7,[13][14][15][16][17]. Although LAIs used to be reserved for patients with frequent relapses or poor adherence [5], the early use of LAIs is increasingly being advocated [10,18,19] and recommended for consideration as a first-line treatment for any patient for whom long-term antipsychotic treatment is needed [20].…”

“…AOM was shown to have comparable efficacy and tolerability to orally administered aripiprazole (OA) in an Asian randomized study [8]; however, there was no significant difference in treatment persistence between the two formulations. Outside Asia, a few studies previously suggested the advantage of AOM for the longer treatment persistence over oral antipsychotics in realworld clinical settings [15,16], but these were not direct comparisons with OA. If real-world evidence suggests such an advantage of AOM over OA in long-term treatment persistence, it would add to clinicians' knowledge and may change their attitudes toward the use of the formulation, which could potentially encourage its use in clinical practice.…”

Antipsychotic patterns in outpatients with schizophrenia in China

“…Even if there are studies show that treatment interruptions with oral medications are by far one of the main causes of schizophrenia relapse and rehospitalization, [ 21 ] the use of LAIs should be considered in optimize adherence, improve treatment outcomes, and enhance functioning by reducing the frequency of administration, [ 22 , 23 ] the prescribing rate of long-acting injectable formulations of risperidone and paliperidone in this study isvery low. The barriers to LAIs use may be insufficient psychiatrists’ clinical understanding of the use of LAIs, the lack of patient insight into the disease and the treatment, and the limitations on healthcare policy.…”