Abstract
BackgroundPaliperidone palmitate is a 2nd generation long-acting injectable (LAI) antipsychotic which is increasingly prescribed for patients with chronic schizophrenia. However, it is more expensive than 1st generation LAI antipsychotics and little is known about its effectiveness in a real world clinical setting. We sought to address this issue by analyzing a large electronic case register of patients with schizophrenia treated with LAI antipsychotics.MethodsData were obtained from 1,281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register who were treated with an LAI antipsychotic between 1st April 2011 and 31st January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were extracted using the Clinical Record Interactive Search tool (CRIS) and analyzed in each of the 3 years before and after LAI prescription using multivariable regression.ResultsPatients who received paliperidone palmitate (n=430; 33.6%) spent more time in hospital (β coefficient 12.3 days, 95% CI 2.3 to 19.2, p=0.001) and were admitted to hospital more frequently (IRR 1.44, 95% CI 1.29 to 1.61, p<0.001) in the year prior to treatment than those treated with other LAI antipsychotics (n=851, 66.4%). However, there were no significant differences between paliperidone and the other LAI antipsychotics in the 3 years after initiation with respect to the number of days spent in hospital (β coefficient 5.4 days, 95% CI -57.3 to 68.2, p=0.86) or frequency of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p=0.82).DiscussionPaliperidone palmitate was more likely to be prescribed in patients with more severe illness, as indicated by a history of more frequent and lengthy hospital admissions prior to initiation. The absence of differences in outcomes after initiation indicates that the effectiveness of paliperidone palmitate was similar to that of other LAI antipsychotics. However, paliperidone palmitate may be better tolerated than other 1st generation LAI antipsychotics with a lower rate of discontinuation. These findings merit consideration in relation to the high cost of paliperidone palmitate compared to other LAI antipsychotics.
Highlights
Long-acting injectable (LAI) antipsychotic medications provide a potential solution to the poor adherence to oral therapies in schizophrenia
It has been suggested that exposure to Childhood Trauma (CT) may play a role in the risk for obesity; whether this is the case for Early Psychosis (EP) patients and independently of the impact of medication has yet to be investigated
Body Mass Index (BMI), Weight Gain (WG) and Waist Circumference (WC) were measured and monitored prospectively after psychotropic prescription during a follow-up period of 1 year
Summary
Negative symptoms of schizophrenia are key predictors of long-term disability. It is important to understand whether treatment with long-acting injectable antipsychotics can improve negative symptom psychopathology. The efficacy of PP3M as assessed by relapse rate is comparable to the paliperidone palmitate 1-month formulation (PP1M). The purpose of this post-hoc analysis was to compare the improvement in negative symptoms in patients treated with PP1M and PP3M. Negative subscale and negative symptoms factor scores showed continuous improvements throughout the OL and double-blind phases of the study - mean (SD) at OL baseline and DB endpoint for total negative subscale score and symptom factor score were 23.2 (4.60) and 22.3 (4.87), and 15.9 (4.99) and 14.9 (4.81), both R2:0.16, respectively. Longer continuous treatment with PP3M showed greater benefit This indicates that long-acting therapies are associated with continued improvement in negative symptoms over time. Treatment with LAIs for longer than a year was associated with the greatest improvements in negative symptoms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
