A prospective year-long follow-up of lurasidone use in clinical practice: factors predicting treatment persistence

Abstract

Background:Our aim was to follow up patients prescribed lurasidone over 1 year to determine factors predicting treatment persistence.Methods:We used noninterventional, observational, prospective follow up of patients consecutively prescribed lurasidone in a large inner-city NHS mental health trust. We also performed retrospective analysis of outcomes from patient case notes.Results:Data were available for 69 patients consecutively prescribed lurasidone, of whom three (4%) were lost to follow up. Out of the 66 patients not lost to follow-up, 21 (32%) remained on lurasidone at 1 year. The main reasons for discontinuation were perceived ineffectiveness (49% of discontinuers) and adverse effects (36% of discontinuers), whilst a further seven refused all treatment. Median treatment time on lurasidone was 154 days (95% confidence interval (CI), 33–275). Patients who were not treatment-resistant had a substantially reduced risk of discontinuation, relative risk (RR) 0.18 [95% CI 0.08, 0.41, p < 0.001]. Medium doses (>37–74 mg) of lurasidone reduced the risk of discontinuation by 75% [RR 0.25 (95% CI 0.11, 0.58, p = 0.001)]; high doses (>74–148 mg) reduced the risk of discontinuation by 86% [RR 0.14 (95% CI 0.06, 0.35, p < 0.001)]. Risk of discontinuation was approximately doubled when the reason for prescribing lurasidone was poor tolerability of prior treatment [RR 2.01 (95% CI 1.05, 3.85, p = 0.035)].Conclusion:The likelihood of treatment continuation with lurasidone can be vastly improved by targeting individuals most likely to benefit and by using optimal doses.

Factors predicting relapse and treatment discontinuation with paliperidone 3-monthly long-acting injection: A 2-year naturalistic follow-up study

“…Patients previously considered for or given clozapine had a much higher likelihood of relapse and discontinuation from PPLAIs. We have demonstrated this association in several previous studies [30][31][32][33]. Patients co-prescribed two antipsychotics were at a greater risk of relapse and subsequent discontinuation than patients on PPLAI monotherapy.…”

Identification of clinical phenotypes in schizophrenia: the role of lurasidone

“…According to real-world data, published in 2018 by Osborne, the highest therapy discontinuation for lack of efficacy occurred with low dosages. 55 While, in clinical practice, the intermediate dose appears to be the most useful, the possibility to use a wide range of doses allows the adjustment of the treatment in the different phases of the disease, using a higher dose at the beginning (exacerbation phase), followed by a step-by-step reduction during the maintenance phase. On the other hand, the lower dose (37 mg) may be particularly useful in patients with a predominant emotional component.…”

“…Lurasidone appears to be particularly effective on a group of symptoms, such as disorganized thinking, difficulty in understanding and concentration, poor memory, as witnessed both by data obtained in clinical trials and in the real-world setting. 30,35,55 This effect appears to be related primarily to potent antagonism at serotonin 5-HT 7 as well as to the agonism at 5-HT 1A receptors, which are known to exert a beneficial effect on cognitive function. 56 Although the available evidence regarding interactions with other drugs is limited, this possibility cannot be ruled out completely.…”

Practical Guidance on the Use of Lurasidone for the Treatment of Adults with Schizophrenia

“…A real-world assessment of treatment adherence in patients with schizophrenia, based on insurance claims, demonstrated that adherence to lurasidone was better than adherence to other oral atypical antipsychotics [42]. In a subsequent prospective, non-interventional, observational study of patients consecutively prescribed lurasidone in a UK mental health trust, three variables were found to be significantly associated with treatment discontinuation: treatment resistance at initiation of lurasidone, poor tolerability to the antipsychotic prescribed immediately prior to initiating lurasidone and low lurasidone doses, compared with medium and high doses [43]. The authors concluded that adherence to lurasidone is likely to be improved by early dose optimisation and by targeting patients who are most likely to benefit from treatment (i.e.…”

“…The authors concluded that adherence to lurasidone is likely to be improved by early dose optimisation and by targeting patients who are most likely to benefit from treatment (i.e. those without evidence of treatment resistance) [43] (see section Dosing for more information on the importance of early dose optimisation).…”