Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate Among Veterans with Schizophrenia

Abstract

Purpose: Compared to once-monthly paliperidone palmitate (PP1M), once-every-3-months paliperidone palmitate (PP3M) reportedly increases treatment adherence. The objective of this study was to compare treatment patterns, utilization, and costs among Veterans Health Administration (VHA) patients with schizophrenia who transitioned to PP3M versus those remaining on PP1M. Patients and Methods: Adult VHA patients with ≥2 health care encounters (inpatient or outpatient) that included a schizophrenia diagnosis who initiated PP1M between January 1, 2015, and March 31, 2018 (identification period) were included in this exploratory retrospective cohort study. Propensity scores were used to match cases (PP1M users who transitioned to PP3M during the identification period) with controls (any patient initiating PP1M during the identification period). Data were assessed until death, health plan disenrollment, or study end. Outcomes were compared using chi-square and t-tests. Results: A total of 257 eligible PP3M and 2973 eligible PP1M patients were identified among adult VHA patients; mean ages were 53.1 and 53.7 years, respectively. After propensity score matching, the PP3M and PP1M cohorts each held 111 patients. Comorbidities of patients treated with PP3M versus PP1M, respectively, included anxiety (12.5% vs 20%; standardized difference [STD] = 20.6), tobacco use (28.4% vs 43.2%; STD = 31.2), depressive disorder (26.5% vs 36.2%; STD = 21.1), and substance abuse (37.4% vs 44.2%; STD = 13.9). For the PP3M cohort, adherence (proportion of days covered ≥80%) to any antipsychotic agent was higher (78.4% vs 57.7%, P = 0.0009), and all-cause inpatient lengths of stay (LOS) were shorter (3.0 vs 8.3 days, P = 0.0354). Increased all-cause pharmacy costs with PP3M were offset by reduced all-cause medical costs, resulting in overall health care cost-neutrality. Conclusion:Relative to those remaining on PP1M, VHA patients with schizophrenia who transitioned to PP3M experienced improved antipsychotic medication adherence and significantly shorter all-cause inpatient LOS; costs remained neutral.

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

“…However, consistent with previous studies, second-generation LAIs appear to have better persistence than oral APs [ 50 – 52 ]. This study should be replicated in 5 years, when more data for second generation antipsychotics will be available and there will be longer-acting formulations, which are expected to have a better persistence due to reduced injection frequency [ 53 – 55 ].…”

Treatment Retention Rates of 3-monthly Paliperidone Palmitate and Risk Factors Associated with Discontinuation: A Population-based Cohort Study

“…Importantly, PP3M has been found to be non- inferior to PP1M in terms of efficacy and safety in the clinical trial setting [ 16 ]. Emerging evidence suggests that PP3M may be superior to PP1M in terms of treatment adherence and relapse prevention in the real-world setting [ 17 , 18 ]. However, few studies have explored the factors that affect PP3M treatment retention in a naturalistic setting [ 19 ].…”

Paliperidone–Cation Exchange Resin Complexes of Different Particle Sizes for Controlled Release

“…Schizophrenia is a neuropsychiatric disorder that affects 1% of the world’s population [ 1 ]. Its treatment mainly employs both typical and atypical antipsychotics due to their relatively tolerable profiles and broad clinical activity.…”