PMH46 Treatment Patterns With Aripiprazole Lauroxil Versus Other Atypical Long-Acting Injectable Antipsychotics in Patients With Schizophrenia: A Retrospective Electronic Health Records Database Study

Abstract

To describe treatment patterns among patients with schizophrenia initiating treatment with aripiprazole lauroxil (AL) versus other atypical long-acting injectable (aLAI) antipsychotics (paliperidone palmitate [PP], aripiprazole monohydrate [AM], risperidone microspheres [RIS]) using a unique web-based electronic health record (EHR) system available free to single-provider and small group outpatient practices across the US. Adults (≥18 years) with schizophrenia who had ≥1 aLAI prescription between 10/2015 and 10/2017 and continuous data for 6 months before and 12 months after initial (index) aLAI prescription were identified retrospectively. Post-index outcomes included index aLAI discontinuation, persistence, adherence (proportion of index aLAI days covered [PDC]), switching, and re-initiation. Adjusted odds ratios (ORs) were calculated using AL as the referent. Mean (SD) patient age was 45.9 (15.1) years (N=1730) and 64% of patients were male. Index treatments included AL (n=159), PP (n=954), AM (n=306), and RIS (n=311). Overall, 84% discontinued their index aLAI; adjusted ORs (95% CIs) relative to AL were 0.77 (0.48-1.25; PP), 0.67 (0.39-1.14; AM), and 2.72 (1.40-5.30; RIS). Median times to discontinuation of index aLAI were 90 (AL), 33 (PP), 85 (AM), and 14 (RIS) days. Median PDCs were 24% (AL), 8% (PP), 16% (AM), and 4% (RIS). Overall, 29% of patients switched from their index aLAI; adjusted ORs vs AL for switching were 0.89 (0.59-1.35; PP), 0.44 (0.31-0.63; AM), and 0.86 (0.64-1.17; RIS). Among patients who discontinued their index aLAI, 21% re-initiated (AL, 30%; PP, 19%; AM, 15%; RIS, 26%). Adjusted ORs vs AL for re-initiation of index aLAI were 0.62 (0.40-0.95; PP), 0.45 (0.27-0.76; AM), and 0.95 (0.59-1.53; RIS). In this real-world EHR database study, AL treatment was associated with a lower rate of discontinuation, greater persistence, and better adherence (based on PDC) versus RIS, whereas outcomes were generally comparable between AL and AM or PP groups.