Treatment Patterns, Health Care Resource Utilization, and Spending in Medicaid Beneficiaries Initiating Second-generation Long-acting Injectable Agents Versus Oral Atypical Antipsychotics

Pilon, Dominic; Tandon, Neeta; Lafeuille, Marie-Hélène; Kamstra, Rhiannon; Émond, Bruno; Lefèbvre, Patrick; Joshi, Kruti

doi:10.1016/j.clinthera.2017.08.008

Cited by 82 publications

(105 citation statements)

References 23 publications

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“…Indeed, higher adherence to APs among patients with schizophrenia has been shown to be associated with improved adherence to other medications used to manage comorbidities in these patients [29,30]. Moreover, the improved adherence to APs postversus pre-PP1M transition was evident despite the fact that adherence pre-PP1M transition was higher than reported elsewhere [9,17,21]. By design, patients were required to have at least 30 days of treatment on oral risperidone or oral paliperidone in the 60 days prior to PP1M transition to exclude treatment-naïve patients, which may explain the higher adherence rates observed in the current study relative to other studies.…”

Section: Discussionmentioning

confidence: 90%

“…Findings from this study are consistent with previous studies showing that switching from oral OAAs to LAIs could help improve adherence and outcomes by reducing dosing frequency. A large real-world cohort study of Medicaid patients with schizophrenia showed that patients initiated on second-generation LAIs had better adherence to and persistence with therapy over 12 months compared to those initiated on OAAs [17]. Similarly, in Medicaid patients recently diagnosed with schizophrenia in the US, treatment with PP1M versus OAAs was associated with better adherence, lower use of other psychiatric medications (i.e., antidepressants, anxiolytics, and mood stabilizers), and reduced medical costs resulting from fewer days spent in an inpatient setting [21].…”

Section: Discussionmentioning

confidence: 99%

“…The use of longacting injectables (LAIs) has been associated with improved medication adherence and significantly lower relapse and hospitalization rates in patients with schizophrenia [15,16]. Therefore, switching patients to LAIs could lead to better adherence and outcomes, as reported in a recent real-world study of Medicaid beneficiaries with schizophrenia [17].…”

Section: Introductionmentioning

confidence: 99%

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Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

Patel

Émond

Lafeuille

et al. 2019

Drugs - Real World Outcomes

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177

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Purpose Reducing the dosing frequency of antipsychotics (APs) with long-acting injectables (LAIs) such as once-monthly paliperidone palmitate (PP1M) can improve adherence and clinical outcomes for schizophrenia patients. This US study compared physical and psychiatric comorbidity-related outcomes, AP adherence, healthcare resource utilization (HRU), and costs pre-and post-transition to PP1M among schizophrenia patients treated with oral risperidone/paliperidone pre-PP1M transition. Methods Health insurance claims from the IQVIA™ PharMetrics Plus database (01/01/2012-07/31/2018) were used to identify adults with ≥ 2 schizophrenia diagnoses, ≥ 1 claim for PP1M, and ≥ 30 days of treatment with oral risperidone/ paliperidone in the 60 days before the first PP1M claim (i.e., the index date). Comorbidity-related outcomes, adherence to APs (measured via the proportion of days covered [PDC]), all-cause per-patient-per-month (PPPM) HRU, and all-cause PPPM medical, pharmacy, and total costs (i.e., sum of medical and pharmacy costs) during the 6-month periods pre-and post-transition to PP1M were compared using generalized estimating equation models adjusted for repeated measurements. Analyses were replicated in the subset of patients with ≥ 1 all-cause inpatient stay pre-PP1M transition. Findings Among 427 schizophrenia patients transitioning from oral risperidone/paliperidone to PP1M, the mean age was 41.1 years and 37.9% were female. Following the PP1M transition, patients were less likely to have claims with a diagnosis for psychoses (odds ratio [OR] 0.41; P < 0.001), hypertension (OR 0.80; P = 0.011), depression (OR 0.70; P < 0.001), drug abuse (OR 0.60; P < 0.001), substance-related and addictive disorders (OR 0.73; P = 0.003), bipolar and related disorders (OR 0.59; P < 0.001), sleep-wake disorders (OR 0.68; P = 0.017), anxiety disorders (OR 0.78; P = 0.034), and other conditions that may require a focus of clinical attention (OR 0.58; P < 0.001). Mean PDC by APs was higher post-PP1M (mean = 0.81) versus pre-PP1M (mean = 0.68) transition. Post-PP1M, patients were less likely to have an all-cause emergency room visit (OR 0.51; P < 0.001) or inpatient stay (OR 0.39; P < 0.001) compared to pre-PP1M. All-cause total healthcare costs remained similar post-versus pre-transition to PP1M (mean monthly cost difference [MMCD] = $228; P = 0.260). Pharmacy costs increased post-PP1M (MMCD = $960; P < 0.001), but were offset by decreasing medical costs (MMCD = − $732; P < 0.001), largely driven by lower costs related to inpatient stays (MMCD = − $695; P < 0.001) and emergency room visits (MMCD = − $63; P < 0.001). For patients with ≥ 1 all-cause inpatient stay pre-PP1M transition (N = 177), a more pronounced improvement in comorbidity-related outcomes, a more pronounced reduction in HRU, and a reduction in total healthcare costs (MMCD = − $1308; P < 0.001) were observed post-transition to PP1M. Implications Among schizophrenia patients in the US, transitioning to PP1M following oral risperidone/paliperidone treatment was associated...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

Patel

Émond

Lafeuille

et al. 2019

Drugs - Real World Outcomes

Self Cite

177

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“…In the study by Pilon et al ., persistence to the index treatment (oral SGA, ARI‐LAI, RIS‐LAI, and PP) was defined as having a continuous supply of available medication with no gaps for ≥30, 60, or 90 days and was assessed at 12 months post‐index date. There were no clear differences in the discontinuation rates between the groups.…”

Section: Resultsmentioning

confidence: 99%

“…In a population of patients diagnosed with SCZ spectrum-disorders, Limonsin et al found that the proportion of patients who discontinued pharmacological treatment was significantly higher in the RIS-LAI group than in the PP group. 93 In the study by Pilon et al, 94 persistence to the index treatment (oral SGA, ARI-LAI, RIS-LAI, and PP) was defined as having a continuous supply of available medication with no gaps for ≥30, 60, or 90 days and was assessed at 12 months post-index date. There were no clear differences in the discontinuation rates between the groups.…”

Section: Pubmed Cochrane Librarymentioning

confidence: 99%

Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

Gentile

2019

Psychiatry Clin Neurosci

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Aim The aim of this review was to analyze the discontinuation rates during long‐term treatment with second‐generation antipsychotic long‐acting injection (SGA‐LAI) in adults with either schizophrenia spectrum or bipolar disorders. Methods A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (1 January 2001–12 October 2018) identified 1214 abstracts, which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥36 weeks. Data were extracted from 51 articles meeting the inclusion criteria. Results In all head‐to‐head comparisons, and studies on patients with schizophrenia spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA‐LAI was, at best, similar to that recorded in patients treated with first‐generation antipsychotics in either oral or LAI formulations or with oral SGA. In particular, in most of the SGA‐LAI long‐term studies, the rate of premature dropout was higher than 50%. Conclusion Reviewed data suggest that SGA‐LAI show no clear superiority over less expensive drugs (including first‐generation antipsychotic LAI and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long‐term pharmacological treatment regimens.

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Modeling Complex Pharmacokinetics of Long‐Acting Injectable Products Using Convolution‐Based Models With Nonparametric Input Functions

Goméni

Bressolle-Gomeni

2021

The Journal of Clinical Pharma

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The interest in the development and the therapeutic use of long-acting injectable (LAI) products for chronic or long-term treatments has grown exponentially. The complexity and the multi-phase drug release process represent serious issues for an effective modeling of the PK properties of LAI products. The objective of this paper was to show how convolutionbased models with piecewise-linear approximation of the nonlinear drug release function, can provide an enhanced modeling tool for: a) characterizing the complex PK profiles of LAI formulations with completely different drug release properties, and b) addressing key questions supporting the optimal development of LAI products by simulating the PK time course resulting from different dosing strategies. Convolution-based modeling and simulation were implemented in NONMEM and three case studies were presented to assess the performances of this new modeling approach using PK data of LAI products developed using different technologies and administered using different routes: microsphere technology and aqueous nanosuspension intramuscularly administered, and biodegradable polymer subcutaneously administered. The performance of the convolution-based modeling approach was compared to the performance of conventional parametric models using a reference dataset on theophylline. The results of the comparison indicated that the nonparametric input function provided a more accurate description of the data either in term of global measure of goodness of fit (i.e., AIC and BIC criteria) or in term of performance of the fitted model (i.e., the percent prediction error on Cmax and AUC 0-t).

show abstract

Treatment Patterns, Health Care Resource Utilization, and Spending in Medicaid Beneficiaries Initiating Second-generation Long-acting Injectable Agents Versus Oral Atypical Antipsychotics

Cited by 82 publications

References 23 publications

Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate

Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

Modeling Complex Pharmacokinetics of Long‐Acting Injectable Products Using Convolution‐Based Models With Nonparametric Input Functions

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