Extent of use of long-acting injectable antipsychotics in children and adolescents within Indiana Medicaid

Abstract

Introduction:Oral formulations of the antipsychotics aripiprazole, asenapine, lurasidone, olanzapine, paliperidone, quetiapine, and risperidone are indicated for use in pediatrics for several diagnoses. Long-acting injectable (LAI) antipsychotics are of interest in this special population because they may be used due to convenience and desire to improve adherence, despite limited support in the literature. The primary intent of this study is to provide descriptive information on the use of paliperidone palmitate, risperidone microspheres, aripiprazole extended-release injection, and olanzapine pamoate in pediatric patients within Indiana Medicaid.Methods:This study was a retrospective database analysis, which retrieved information from Indiana Medicaid over a 2-year timeframe spanning from July 1, 2012, through June 30, 2014. The study included the prescription medications filled for all children and adolescents within Indiana Medicaid who received the LAI antipsychotics paliperidone palmitate, risperidone microspheres, aripiprazole extended-release injection, and olanzapine pamoate.Results:From July 1, 2012, through June 30, 2014, 150 Indiana Medicaid patients younger than 18 years old were prescribed a LAI atypical antipsychotic. A total of 1013 LAI atypical antipsychotic doses were billed to Indiana Medicaid during the study period for pediatric patients. Paliperidone palmitate was billed most frequently.Discussion:Long-acting injectable atypical antipsychotics are being prescribed for children and adolescents within Indiana Medicaid, despite minimal clinical evidence supporting use. There is a need for further research in this area to increase generalizability of results and aid in implementation of policies to prevent inappropriate use of LAI antipsychotics in children and adolescents.

What Role for Long-Acting Injectable Antipsychotics in Managing Schizophrenia Spectrum Disorders in Children and Adolescents? A Systematic Review

“…Adolescents placed in foster care could be another indicator for considering the use of LAIA, due to a higher risk of non-adherence, and increased incidence of behavioral difficulties and substance use comorbidities [ 73 ]. In fact, youth in foster care comprised 23.3% of the patients included in one of the studies reviewed [ 28 ] and 16% of the children and adolescents with at least one prescription of LAIA in the study conducted in the Indiana Medicaid system [ 74 ].…”

“…Insight is associated with adherence to treatment [ 77 ]. Worse insight has been associated with more severe symptoms, increased risk of discontinuing treatment, and poorer outcomes [ 74 , 78 , 79 ]. Significantly, it has also been suggested that younger patients may have less insight than adults with SSD [ 75 , 76 , 80 ].…”

Comparison of long-acting injectable antipsychotics with oral antipsychotics and hospital readmission rates in pediatric patients

“…In pediatric populations, oral formulations of second generation antipsychotics (APs) are used in various psychiatric conditions, including schizophrenia, bipolar disorder, and irritability associated with autism-spectrum disorder. 1 Long-acting injectable antipsychotics (LAIAs) demonstrate improved outcomes in adult patients with schizophrenia or bipolar disorder, a population that may particularly struggle with medication adherence. 2–4 The mechanism of LAIAs allows for the release of steady serum concentrations over a longer period of time when compared with oral APs.…”

“… 6 Whereas limited studies conclude that there may be improved clinical outcomes and adherence with using LAIAs when compared with oral counterparts, the lack of data supporting LAIA use in this population may lead to lower use of these formulations. 1 A meta-analysis of studies involving pediatric patients with SSD found clinical improvement of patients using LAIA formulations in up to 12 months of follow-up. 6 A retrospective database analysis concluded that, although there is limited clinical data supporting the safety and efficacy of LAIAs in adolescents, their use in patients with documented nonadherence would be appropriate.…”

Uso de Antipsicóticos Inyectables en Pacientes Prepúberes: Experiencia con un Caso Atípico de alteración conductual con microdeleción 18p11.32-18p11.31

“…Por otro lado, las recomendaciones de dosificación etiquetadas para el uso de LAIAs se basan en poblaciones adultas; por lo tanto, no se conoce la dosificación adecuada para la población pediátrica ni se tienen de datos de seguridad a largo plazo con respecto efectos adversos. Además, no existen datos farmacocinéticos publicados para antipsicóticos LAI en la población pediátrica, lo que lleva a algunas incógnitas como si las diferencias en la masa muscular podrían alterar la liberación o distribución de los antipsicóticos LAI actualmente disponibles (4).…”