<p>Patients’ Preference for Long-Acting Injectable versus Oral Antipsychotics in Schizophrenia: Results from the Patient-Reported Medication Preference Questionnaire</p>

Abstract

Introduction Understanding patients’ preferences for long-acting injectable (LAI) or oral antipsychotics (pills) could help reduce potential barriers to LAI use in schizophrenia. Methods Post hoc analyses were conducted from a double-blind, randomized, non-inferiority study (NCT01515423) of 3-monthly vs 1-monthly paliperidone palmitate in patients with schizophrenia. Data from the Medication Preference Questionnaire, administered on day 1 (baseline; open-label stabilization phase), were analyzed. The questionnaire includes four sets of items: 1) reasons for general treatment preference based on goals/outcomes and preference for LAI vs pills based on 2) personal experience, 3) injection-site (deltoid vs gluteal), 4) dosing frequency (3-monthly vs 1-monthly). A logistic regression analysis was performed to assess the effect of baseline variables on preference (LAIs or pills). Results Data from 1402 patients were available for analysis. Patients who preferred LAIs recognized these outcomes as important: “I feel more healthy” (57%), “I can get back to my favorite activities” (56%), “I don’t have to think about taking my medicines” (54%). Most common reasons for medication preference (LAI vs pills) were: “LAIs/pills are easier for me” (67% vs 18%), “more in control/don’t have to think about taking medicine” (64% vs 14%), “less pain/sudden symptoms” (38% vs 18%) and “less embarrassed” (0% vs 46%). Majority of patients (59%) preferred deltoid over gluteal injections (reasons: faster administration [63%], easier [51%], less embarrassing [44%]). In total, 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing citing reasons: fewer injections [96%], fewer injections are less painful [84%], and fewer doctor visits [80%]. From logistic regression analysis, 77% of patients preferred LAI over pills; culture and race appeared to play a role in this preference. Conclusion Patients who preferred LAI antipsychotics prioritized self-empowerment and quality-of-life-related goals. When given the option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.

Patients’ perspectives on three-monthly administration of antipsychotic treatment with paliperidone palmitate – a qualitative interview study

“…An important argument for the switch was that PP1M and PP3M involved the same active component, and that frequency was the main difference. This is in line with the findings in Lai and Margolese [23] and a recent large-scale patient-reported questionnaire study [21]. The results also showed that most switches from PP1M to PP3M were recommended by the patients' health care providers, and that trusting the professionals was imperative for this decision.…”

“…In contrast, a recent large scale post-hoc analysis of patients medication preference and a multi-country questionnaire study reported that patients had a higher inclination to prefer PP3M over PP1M due to convenience and better control [21,22]. This was supported by the results from interviews with 14 patients, showing that PP3M was perceived as more convenient and with benefits when compared to PP1M [21][22][23]. So far, when investigating patients' perspectives, most studies have used questionnaires on health-related quality of life and patient satisfaction and have not utilized the potential of qualitative research methods.…”

“…One study showed that patients preferred both monthly and three-monthly injectables to daily oral medication, but that they did not prefer three-monthly to monthly injections [20]. In contrast, a recent large scale post-hoc analysis of patients medication preference and a multi-country questionnaire study reported that patients had a higher inclination to prefer PP3M over PP1M due to convenience and better control [21,22]. This was supported by the results from interviews with 14 patients, showing that PP3M was perceived as more convenient and with benefits when compared to PP1M [21][22][23].…”

Attitudes and Willingness to Accept Long-Acting Injections for Patients With Schizophrenia in Beijing: A Cross-Sectional Investigation Based on Samples From the Communities

“…This study makes significant contributions to the current field of mental health and the treatment of LAI. First of all, unlike most previous clinical studies based on patients in psychiatric hospitals ( 59 , 60 ), this study is on a natural sample population of community patients. And before confirming the sample, investigators don't know whether respondents have been treated with LAI or oral medication.…”

Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis

“…56 Another study asked patients if they preferred LAI or oral medications; none of the patients preferring LAIs said that their preference was because LAIs were "less embarrassing," while 46% of patients who preferred oral medications chose this reason. 70 A further study comparing self-stigma between patients taking LAIs and oral medications found no significant differences in any ISMI domains between the two groups. 71 Studies investigating the differing perspectives of HCPs versus patients reported similarly conflicting results.…”