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

Iwata, Nakao; Inagaki, Ataru; Sano, Hiromi; Niidome, Kazunari; Kojima, Yoshitsugu; Yamada, Shigehiro

doi:10.1007/s12325-020-01396-w

Cited by 13 publications

(12 citation statements)

References 33 publications

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“… 10 In Japan, where LAI antipsychotics are still underused, a real-world study using the JMDC database demonstrated patients treated with LAI antipsychotics (ie, aripiprazole) were significantly less likely to discontinue treatment than those receiving aripiprazole orally (adjusted hazard ratio: 0.54; p < 0.0001). 32 In the above studies, the mean age (range) of patients with BD who received LAI and oral antipsychotics was 36.1–38.4 years and 39.1–39.3 years, respectively, 10 , 32 which was comparable with the age group of younger BD patients in our study (ie, <30 years or 30–40 years) who had poor medication adherence. Hence, the use of LAI antipsychotics could be an alternative treatment option, especially in younger patients.…”

Section: Discussionsupporting

confidence: 72%

Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database

Inoue¹,

Sano²,

Kojima³

et al. 2021

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Purpose This study aimed to describe real-world treatment patterns and medication adherence among patients with bipolar disorder (BD) in Japan. Patients and Methods Adult patients with a BD diagnosis were identified between July 2013 and February 2018, using an employment-based health insurance claims database from the JMDC Inc. Treatment patterns of target drugs (mood stabilizers, antipsychotics) and adherence (measured by the proportion of days covered [PDC]) were assessed during the first- through third-year follow-up. Adherence was also assessed for patient subgroups. Results The analyzed population included 13,788 patients with BD. They were mostly prescribed sodium valproate, lithium, or aripiprazole (range: 21.1–27.4%) across 3 years of follow-up, whereas lamotrigine was prescribed to 11.2–12.8% of patients. Benzodiazepines (70–87%) and antidepressants (52–71%) were commonly prescribed during all three follow-up periods. The mean PDC among all patients with BD was 0.51 during the first and increased to 0.61 during the third year. The mean PDC was 0.42 (first year) in patients aged <30 years and 0.49 in those aged 30–40 years. The PDC was 0.44–0.61 (depending on the drug class) in those who were prescribed a single-class target drug and 0.68–0.83 in those prescribed two drug classes concomitantly. Conclusion This study documented generally low medication adherence among patients with BD, and those at young age. These patients may require more attention.

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Section: Discussionsupporting

confidence: 72%

Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database

Inoue¹,

Sano²,

Kojima³

et al. 2021

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“…Among British cohorts of patients beginning LAI treatment, discontinuation rates at 1 year were 35-40% for paliperidone once monthly [29][30][31] and 68-55% for risperidone LAI [32,33]. Iwata et al [15] found discontinuation rates for aripiprazole of around 40% among patients with schizophrenia in Japan at 12 months of follow-up [15], whereas, in Canada, treatment retention at 18 months was 77% for a group of 70 patients with schizophrenia initiated with risperidone LAI [34]. On the other hand, in the USA, Pilon et al [35] found notably higher discontinuation rates, with more than 60% of patients with schizophrenia using aripiprazole LAI, paliperidone once monthly and risperidone LAI discontinuing treatment after 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…antipsychotics, whereas studies comparing different LAIs with each other either did not include the most recently marketed SGA LAIs or did not explore sociodemographic and clinical characteristics possibly associated with LAI adherence [14][15][16].…”

Section: Key Pointsmentioning

confidence: 99%

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

et al. 2021

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Background Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods The STAR Network 'Depot Study' was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4-44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3-43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4-84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6-40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6-27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742-0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003-4.634; p = 0.049). Conclusions Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation.

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“…Numerous studies have also replicated the superiority of LAIs over oral APs in terms of adherence, all-cause discontinuation, rehospitalization, cost effectiveness, and functioning in the treatment of schizophrenia as well as bipolar disorder regardless of geographic regions conducted clinical trials and studies [34][35][36][37][38].…”

Section: Lais Are Better Than Oral Aps In Prevention Of Relapse and Treatment Adherencementioning

confidence: 99%

“…It is well-known that LAIs have superiority in relapse and rehospitalization over oral APs in a number of clinical trials and meta-analysis [34][35][36][37][38] despite some debates on this issue [39] due to diverse possible biases such as study methodology, expectation bias, natural illness course, and time effect [40]; indeed, the superiority of LAIs over oral APs were not found in some randomized and con-trolled clinical trials (RCTs), while LAIs were superior to oral APs in most mirror-image and some large cohort studies, indicating a mandatory change on study design in consideration of formula difference. A possible solution would be the implementation of a practical effectiveness trial in which post-randomization involvement should be kept to a minimum for better reflection of routine practice [40].…”

Section: Lais Are Better Than Oral Aps In Prevention Of Relapse and Treatment Adherencementioning

confidence: 99%

Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not?

Pae

Han

Bahk

et al. 2021

Clin Psychopharmacol Neurosci

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Antipsychotic monotherapy (APM) is considered best-acceptable treatment option regardless of antipsychotic class and formulation types for treating schizophrenia. However, antipsychotic polypharmacy (APP) has been also widely utilized in routine clinical practice. Despite APP has some clinical benefits it has also numerous pitfalls in relation with increased total number and doses of APs leading to adverse events as well as decrease of treatment adherence and persistence resulting in poor clinical outcomes. Recent introduction of long-acting injectable antipsychotics (LAIs) to the market has offered a chance for better medication adherence/persistence and also provided a simplification of treatment regime leading to more stabilized treatment for schizophrenia patients. When we cannot stay away from APP in the treatment of schizophrenia, clinicians need to find more proper APP regimens and thereby utilization of APP in efficient way should be a practical strategy to benefit schizophrenia patient in a real world treatment setting. With this regard, LAIs can be one of available APP regimen for treatment of schizophrenia in routine practice since their clinical utility and pharmacokinetic stability over oral APs have been well-elaborated today. However, when we have to commence LAIs as a part of APP with oral APs or other LAIs, every effort should be made before doing so whether or not validated and available treatment options or other clinical factors were not done or evaluated yet. Any treatment guidelines do not support APP regardless of the formulation of APP regimen or address two or more LAIs for treatment of schizophrenia till today.

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

Cited by 13 publications

References 33 publications

Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database

Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not?

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