Achieving greater continuation of treatment is a key element to improve treatment outcomes in schizophrenia patients. However, reported treatment continuation can differ markedly depending on the study design. In a retrospective setting, treatment continuation remains overall poor among patients using antipsychotics. This study aimed to document the difference in treatment continuation between four long-acting injectable antipsychotics based on the QuintilesIMS LRx databases, national, longitudinal, panel based prescription databases of retail pharmacies, in the Netherlands and Belgium. Paliperidone palmitate once monthly, risperidone microspheres, haloperidol decanoate, and olanzapine pamoate were studied. This study demonstrated significantly higher treatment continuation of paliperidone palmitate once monthly compared to risperidone microspheres (p-value<0,01) and haloperidol decanoate (p-value<0,01) in both countries, a significantly higher treatment continuation of paliperidone palmitate once monthly compared to olanzapine pamoate in the Netherlands (p-value<0,01), and a general trend towards better treatment continuation versus olanzapine pamoate in Belgium. Analysing the subgroup of patients without previous exposure to long-acting antipsychotic treatment revealed the positive impact of previous exposure on treatment continuation with a subsequent long acting treatment. Additionally, the probability of restarting the index therapy was higher among patients treated with paliperidone palmitate once monthly compared to patients treated with risperidone microspheres and haloperidol decanoate. The data source used and the methodology defined ensured for the first time a comparison of treatment continuation in a non-interventional study design for the four long-acting injectable antipsychotics studied.

To evaluate the effect of lisdexamfetamine dimesylate (LDX) and changes in binge eating (BE) days/week and BE episodes/week on disability in patients with protocol-defined moderate to severe binge eating disorder (BED) over 12 weeks. Methods: In two identically designed, 12-week, double-blind, placebo (PBO)-controlled trials, adults meeting DSM-IV-TR BED criteria were randomized (study 1, N= 383; study 2, N= 390) to PBO or LDX (50 or 70 mg). LDX was statistically superior to PBO in reducing the number of BE days/week (the primary endpoint) and showed numerical improvements in BE episodes/week (a secondary endpoint). The trials assessed disability with Sheehan Disability Scale (SDS) as an exploratory endpoint. Observations corresponding to visits from baseline to week 12 were analyzed; data were pooled across studies. The current post hoc analyses were performed using mixed-effect logistic regression models to determine the relationship between: (1) LDX therapy and disability, and (2) BE days/week and disability, and BE episodes/week and disability. P-values are unadjusted and presented for descriptive purposes only. Results: LDX therapy showed a numeric improvement on disability as measured by SDS. The odds ratio (OR)/week for disability (> 0 score) measured by SDS total score for LDX relative to placebo was 0.70 (P≤ 0.001). Higher BE frequency counteracted the improvement in disability which was significant in the lowest tertile of BE frequency (tertile 3). ORs/week for disability (> 0 score) measured by SDS total score in BE days/week tertiles 1, 2 and 3 (relative to tertile 1) were 0.66, 1.37 and 1.72, and in BE episodes/week 0.66, 1.44 and 1.69, respectively (all P≤ 0.001). ConClusions: Findings of this longitudinal analysis indicate that LDX therapy has a positive effect on disability, as measured by SDS, of BED patients. The analysis also showed that reduction in both BE days/week and BE episodes/week is associated with improvement in disability over 12 weeks.

A461caring. It provided direct payments and aid to allow carers to take a break from caring (with or without the person cared for). Here we investigate the effects of the scheme on carers' HRQL. Methods: In order to conduct the evaluation, a quality of life survey was conducted. Carers were asked to complete questionnaires at Week 0 and Week 12. One of the questionnaires selected for inclusion in both surveys was the EQ-5D (5 level). Results: Of the 155 patients completing the Week 0 survey, 97 completed at least some of the Week 12 survey. There was some evidence to suggest a small improvement in HRQL via the EQ-5D-5L (0.62 to 0.66, n= 86). Both pre-and post-intervention the estimated mean utility of the cohort was significantly lower than 0.81; the value that would be predicted in the general population given the age and gender characteristics of the cohort. ConClusions: Informal carers have significantly lower HRQL than age-matched controls. While it is not possible to draw firm conclusions around the benefit derived from the intervention, due to the lack of control arm, the evaluation of a carer breaks service indicates a potentially modest benefit.

IntroductionLong-acting antipsychotics (e.g. 1-monthly (PP1M) / 3-monthly (PP3M) injection forms of paliperidone palmitate) have been developed to improve treatment continuation in schizophrenia patients.ObjectivesTo assess risk factors of treatment discontinuation in patients on paliperidone palmitate and risperidone microsphere. Additionally, treatment continuation between patients with PP1M and PP3M was compared.MethodsThe IQVIA Longitudinal Prescription databases were used. Risk factors of treatment discontinuation were identified by a multilevel survival regression using Cox proportional hazards model. Kaplan Meier analyses were performed by identified significant risk factors.Results25,361 patients (France: 9,720; Germany: 14,461; Belgium: 1,180) were included. Over a one-year follow-up period, a significant higher treatment continuation was observed for patients newly initiated on paliperidone palmitate (46.2%) than those initiated on risperidone microspheres (14.6%). Additionally, a significantly higher treatment continuation was found for ‘stable’ PP3M patients (81.8%) than ‘stable’ PP1M patients (62.9%). Patients were more likely to discontinue when drugs prescribed by GP only (HR = 1.68, p < 0.001 vs. psychiatrist only) or being females (HR = 1.07, p < 0.001), whereas discontinuation rate decreased with age (31-50 years: HR = 0.95, p = 0.006 and > 50 years: HR = 0.91, p < 0.001 vs. 18-30 years).ConclusionsPaliperidone palmitate was associated with a significantly higher treatment continuation than risperidone microspheres. Treatment continuation is likely to be improved by targeting young patients (18-30 years), empowering GPs with mental health knowledge and managing patients by a collaborative primary care-mental health model. Further research is needed to understand why females have more treatment discontinuation.DisclosureRui Cai, Flore Decuypere and Pierre Chevalier are IQVIA employees and served as paid consultants to Janssen during the conduct of this study. Antonie Wimmer, Pascal Guillon, Stefan Pype, Annabelle Godet, Valeria Timtschenko are Janssen employees.

Background Long-acting antipsychotics (e.g. 1-monthly (PP1M) / 3-monthly (PP3M) injection forms of paliperidone palmitate) have been developed to improve treatment continuation in schizophrenia patients. We aim to assess risk factors of treatment discontinuation of patients on paliperidone palmitate and risperidone microsphere. Additionally, treatment discontinuation between patients with PP1M and PP3M was compared. Methods The IQVIA Longitudinal Prescription databases were used. Risk factors of treatment discontinuation were identified by a multilevel survival regression using Cox proportional hazards model. Kaplan Meier analyses were performed by identified significant risk factors. Results Twenty-five thousand three hundred sixty-one patients (France: 9,720; Germany: 14,461; Belgium: 1,180) were included. Over a one-year follow-up period, a significant lower treatment discontinuation was observed for patients newly initiated on paliperidone palmitate (53.8%) than those on risperidone microspheres (85.4%). Additionally, a significantly lower treatment discontinuation was found for ‘stable’ PP3M patients (19.2%) than ‘stable’ PP1M patients (37.1%). Patients were more likely to discontinue when drugs were prescribed by GP only (HR = 1.68, p < 0.001 vs. psychiatrist only) or if they were female (HR = 1.07, p < 0.001), whereas discontinuation decreased with age (31–50 years: HR = 0.95, p = 0.006 and > 50 years: HR = 0.91, p < 0.001 vs. 18–30 years). Conclusions This study demonstrates that patients stay significantly longer on treatment when initiated on paliperidone palmitate as compared to risperidone microspheres. It also indicated a higher treatment continuation of PP3M over PP1M. Treatment continuation is likely to be improved by empowering GPs with mental health knowledge and managing patients by a collaborative primary care-mental health model. Further research is needed to understand why females and younger patients have more treatment discontinuation.