Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

Abstract

Background Long-acting injectable (LAI) antipsychotics, compared with oral antipsychotics (OA), have been found to significantly improve patient outcomes, including reduced hospitalizations and emergency room (ER) admissions and increased medication adherence among adult patients with schizophrenia. In turn, the clinical benefits achieved may translate into lower economic burden. Real-world evidence of the comparative effectiveness of LAI is needed to understand the potential benefits of LAI outside of the context of clinical trials. This study aimed to provide a comprehensive synthesis of recent published real-world studies comparing healthcare utilization, costs, and adherence between patients with schizophrenia treated with LAI versus OA in the United States. Methods In this systematic literature review, MEDLINE ® was searched for peer-reviewed, real-world studies (i.e., retrospective or pragmatic designs) published in English between January 1, 2010 and February 10, 2020. Comparative studies reporting hospitalizations, ER admissions, healthcare costs, or medication adherence (measured by proportion of days covered [PDC]) in adults with schizophrenia treated with LAI versus OA (or pre-vs post-LAI initiation) in the United States were retained. Random effects meta-analyses were conducted among eligible studies to evaluate the association of LAI versus OA use on hospitalizations, ER admissions, healthcare costs, and treatment adherence. A sensitivity analysis among the subset of studies that compared OA with paliperidone palmitate once monthly (PP1M), specifically, was conducted. Results A total of 1083 articles were identified by the electronic literature search, and two publications were manually added subsequently. Among the 57 publications meeting the inclusion criteria, 25 provided sufficient information for inclusion in the meta-analyses. Compared with patients treated with OA, patients initiated on LAI had lower odds of hospitalization (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.54-0.71, n = 7), fewer hospitalizations (incidence rate ratio [IRR] [95%

Utilization of Polymeric Micelles as a Lucrative Platform for Efficient Brain Deposition of Olanzapine as an Antischizophrenic Drug via Intranasal Delivery

“…Particle size (Y1) = +49.91 A + 42.96 B + 88.44 C − 30.24 AB − 68.56 AC − 80.96 BC (1) The data in Table S2A and the associated ANOVA findings (Table S3A) show that the regression coefficients of the tested CPPs all had p values < 0.05, suggesting that they have a significant influence on PM particle size.…”

“…Schizophrenia is a mental disorder characterized by hallucinations, alterations in cognition, behavior, emotion, and disorganized speech that severely cause distress and daily functional impairment [1,2]. Approximately 23 million people worldwide are suffering from schizophrenia, 1% of whom are in adolescence or early adulthood [3,4].…”

A review on generation of real-world evidence

“…The PRIDE study was a real-world study for superiority of paliperidone to oral antipsychotics in schizophrenia that led to label expansion by FDA in 2018 [33]. A metanalysis of retrospective and pragmatic real-world studies reported a discernible benefit of long-acting injectable (LAI) antipsychotics over oral antipsychotics in Schizophrenia in terms of cost-effective and sustained patient outcomes [34].…”

Use of Long-Acting Injectable Antipsychotics in Inpatients with Schizophrenia Spectrum Disorder in an Academic Psychiatric Hospital in Switzerland

“…Fourth, LAIs significantly reduce the rate of hospitalization, according to a recent meta-analysis [ 10 ]. Thus, LAIs are not only clinically effective but also reduce medical costs, as shown in a meta-analysis [ 11 ]. Another benefit of LAIs is the lower risk of being arrested or incarcerated in patients treated with LAIs compared to OAPs, in a randomized review board-blinded study [ 12 ].…”