Abstract
Paliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics. EHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription. Patients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) -57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82). Paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.
Highlights
One of the key factors that limits the clinical effectiveness of treatment of psychotic disorders with oral antipsychotic medication is poor adherence
Long-acting injectable (LAI) antipsychotics may provide a means of overcoming this problem (Tiihonen et al 2011; Marcus et al 2015), a minority of patients prescribed antipsychotics (Pinto et al 2010) are treated with long-acting injectable (LAI)
A review comparing different study designs to evaluate outcomes associated with LAIs (Haddad et al 2015) found that two recent randomized controlled trials (RCTs), which had a pragmatic design (Alphs et al 2015; Schreiner et al 2015) demonstrated better outcomes with paliperidone palmitate compared with oral antipsychotics
Summary
One of the key factors that limits the clinical effectiveness of treatment of psychotic disorders with oral antipsychotic medication is poor adherence. A meta-analysis of mirror-image studies, where periods of oral and LAI antipsychotic in the same patients are compared, showed that LAIs reduced the relative risk of hospitalization by half (Kishimoto et al 2013). These apparently conflicting findings may reflect an effect of study design that is particular to LAIs (Kirson et al 2013). Patients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. The absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics
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.
