How can we improve the care of patients with schizophrenia in the real-world? A population-based cohort study of 456,003 patients

Abstract

An important step to improve outcomes for patients with schizophrenia is to understand treatment patterns in routine practice. The aim of the current study was to describe the long-term management of patients with schizophrenia treated with antipsychotics (APs) in real-world practice. This population-based study included adults with schizophrenia and who had received ≥3 deliveries of an AP from 2012–2017, identified using a National Health Data System. Primary endpoints were real-life prescription patterns, patient characteristics, healthcare utilization, comorbidities and mortality. Of the 456,003 patients included, 96% received oral APs, 17.5% first-generation long-acting injectable APs (LAIs), and 16.1% second generation LAIs. Persistence rates at 24 months after treatment initiation were 23.9% (oral APs), 11.5% (first-generation LAIs) and 20.8% (second-generation LAIs). Median persistence of oral APs, first-generation LAIs and second-generation LAIs was 5.0, 3.3, and 6.1 months, respectively. Overall, 62.1% of patients were administered anxiolytics, 45.7% antidepressants and 28.5% anticonvulsants, these treatments being more frequently prescribed in women and patients aged ≥50 years. Dyslipidemia was the most frequent metabolic comorbidity (16.2%) but lipid monitoring was insufficient (median of one occasion). Metabolic comorbidities were more frequent in women. Standardized patient mortality remained consistently high between 2013 and 2015 (3.3–3.7 times higher than the general French population) with a loss of life expectancy of 17 years for men and 8 years for women. Cancer (20.2%) and cardiovascular diseases (17.2%) were the main causes of mortality, and suicide was responsible for 25.4% of deaths among 18–34-year-olds. These results highlight future priorities for care of schizophrenia patients. The global persistence of APs used in this population was low, whereas rates of psychiatric hospitalization remain high. More focus on specific populations is needed, such as patients aged >50 years to prevent metabolic disturbances and 18–34-year-olds to reduce suicide rates.

Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review

“…Most studies reported limited use of AP LAI (2% to 25%) [28,29,31,35,43,44,46,50,55,59,62,68,69,72,73,80,85,90,93,96], while a few studies reported significant use of AP LAI (35.6% to 58%) [27,45,54]. The most common AP LAI used were risperidone (38.8%) [97], zuclopenthixol (11.4-17.8%) [27,97], and fluphenazine (5.4-52.4%) [27,54,97].…”

“…Adjunctive MS was prescribed at a rate of 13.6-51.6% in the US [33,41,71,78,103,109], 3.1-28.5% in Europe [29,31,35,56,79,80,85,94,96,107], and 0.9% in Nigeria [77]. Adjunctive MS use was highest in Italy when compared to European countries [79].…”

“…Details of the various clinical correlates with adjunctive MS use are seen in Table 3. [96] Being male [88] Being Caucasian [109] Country/study site [65,69,79,88]…”

“…The prevalence of adjunctive AD use was 4.4-27.4% in China and Hong Kong [28,46,47,64,74], 47.7% in Taiwan [55], 8-42.3% in Japan [44,47,86,87], 8.5% in Korea [75], and 8.7-11.7% in several countries across Asia [19,70]. Adjunctive AD was prescribed at rates of 30.8-56.2% in the US [33,41,59,71,78,93,103], 5.4-45.7% in Europe [27,29,31,32,35,36,58,62,73,[79][80][81]85,93,94,96,107], 4.4% in Nigeria [77], and 36% in Uzbekistan [32]. AD use was highest in the UK/Ireland and France across Western countries [79].…”

Peculiarities of personalized selection of antipsychotic drugs for schizophrenia treatment

“…Безперервне та тривале лікування АП має важливе значення для запобігання рецидивам, частим госпіталізаціям та протидії подальшій інвалідизації пацієнта, що є основою ефективного лікування шизофренії [6].…”