Abstract
BackgroundSchizophrenia is a severe condition that affects approximately 1% of the population. Certain elements of antipsychotic treatment can only be examined in large population, thus the need for population-based real-world analyses has been increasing.Patients and methodsHungarian National Health Fund database includes all healthcare data of the population of Hungary. All patients diagnosed with schizophrenia between 01.01.2006 and 31.12.2015 were included in the study. We analyzed all patients with newly initiated second-generation antipsychotic during the inclusion period (01.01.2012–31.12.2013). Patients were followed for 2 years. All-cause treatment discontinuation served as the primary outcome of the study. Patients with newly initiated long-acting injectable treatments were further investigated in stratified analyses based on their previous treatment.Results106,624 patients had schizophrenia diagnosis during the study period. 12,232 patients met the inclusion criteria for newly initiating second-generation antipsychotic during the inclusion period. The proportion of patients still on treatment after 1 year for oral treatments varied between 17% (oral risperidone) and 31% (oral olanzapine) while the analogous data for long acting injectables were between 32% (risperidone long acting) and 64% (paliperidone long acting one monthly). The 2-year data were similarly in favor of long-actings. Median time to discontinuation in the oral group varied between 57 days (clozapine) and 121 days (olanzapine). The median time to discontinuation for long-actings was significantly longer: between 176 and 287 days; in case of paliperidone long acting, median was not reached during the observation period. Patients receiving long-acting treatment switched from another long-acting remained on the newly initiated treatment significantly longer than those switched from orals.ConclusionOur results indicate the superiority of second generation long-acting antipsychotics with regard to rates of treatment discontinuation and periods of persistence to the assigned medication.
Highlights
Schizophrenia is a chronic and severe condition that has a significant and long-lasting impact on the individual patients, their caregivers, and society
Based on the unadjusted analyses, long acting injectable (LAI) performed significantly better than oral APs in terms of hazard ratio (HR) for discontinuation as follows: paliperidone long acting injection 1 monthly (PP1M) and olanzapine long acting injection (OLAI) were significantly better than all oral APs while risperidone long action injection (RLAI) was better than most of the oral APs, this difference was not significant versus oral olanzapine (OLAN) (HR = 1.02, p = 0.663) and paliperidone oral (PALI) (HR = 1.2, p = 0.111)
For PP1M, almost 40% of the patients were switched from another LAI, while for RLAI and OLAI the proportion of patients switched from other LAI was very small (2–3%)
Summary
Schizophrenia is a chronic and severe condition that has a significant and long-lasting impact on the individual patients, their caregivers, and society. While discontinuation of treatment has been accepted as a proxy for treatment failure [5] as it is widely perceived as the main reason behind relapse, recently questions were raised whether certain patient population may benefit from a no-treatment period. A number of real-life studies have recently been published reflecting both on different aspects of potential hazard of treatment discontinuation and comparing the effectiveness of different treatments [8,9,10,11,12,13,14], further pragmatic, long term and full-population-based studies are needed to help understand the impact of the condition and the differences between treatments [15]. Certain elements of antipsychotic treatment can only be examined in large population, the need for population-based real-world analyses has been increasing.
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