February 08, 2017
By Will Boggs MD
NEW YORK (Reuters Health) – The long acting injectable (LAI) antipsychotic paliperidone palmitate improves adherence and decreases hospital visits in patients with schizophrenia, researchers from Canada report.
"Long acting injectables should be initiated earlier in the disease process to prevent a very long index hospitalization,” Philippe D. Vincent from the University of Montreal told Reuters Health by email. “Nonadherence should be detected and taken care of in outpatients rather than in a psychotic crisis requiring hospitalization.”
Nonadherence is one of the major issues complicating the treatment of schizophrenia, with nonadherence in many studies exceeding 40%. Long-acting intramuscular delivery was developed in hopes of resolving this issue.
Vincent and colleagues investigated whether adherence to paliperidone palmitate (PP) is better than adherence to oral antipsychotics in their retrospective mirror-image study of 114 patients with schizophrenia (70%) or schizoaffective disorder (30%).
The analysis considered four periods: A, 1 year treatment with oral antipsychotic; B, index hospitalization before 1st PP injection; C, index hospitalization after 1st PP injection; and D, 1 year treatment with PP.
During period A (1 year treatment with oral antipsychotic), 69% of patients bought less than 70% of their drugs and 20% never filled their prescriptions, according to the January 23rd Schizophrenia Research online report.
All but one patient was hospitalized while on oral antipsychotics in period A, whereas 61% of patients were never hospitalized while on PP in period D (1 year treatment with PP). The number needed to treat with PP for 1 admission-free patient was 2.7.
On average, patients were hospitalized 9.8 fewer days during period D than during period A.
The combined period CD (index hospitalization after 1st PP injection, and 1 year treatment with PP) saved $326 per patient-year in total drug and inpatient costs, compared with the combined period AB (1 year treatment with oral antipsychotic, and index hospitalization before 1st PP injection).
Period D saved $1788 per patient-year in total spending, compared with period A. The cost of PP itself represented only 16.5% of total spending per patient.
“Our study sheds light on another problem to investigate, which is the long delay before LAI are initiated,” the researchers noted.
They continued, “Our patients suffered from schizophrenia or schizoaffective disorder for a mean 10 years, had a mean adherence rate of 43% and still, PP was their first LAI trial. We believe that a better monitoring of adherence by community pharmacists, and better communication with psychiatrists, would detect earlier patients needing support with their medication, and prevent costs and suffering associated with schizophrenia.”
“Don’t refrain from using long acting injectables because of cost issues,” Vincent advised. “Ask pharmacists to give physicians a call when patients don’t present themselves for oral drug renewal.”
Janssen Canada supported the study with an unrestricted educational grant. Two of the six authors have received grants and/or personal fees from Janssen.
Schizophrenia Res 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - http://about.reuters.com/fulllegal.asp