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Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

  • R. Patel (a1), E. Chesney (a1), M. Taylor (a1), D. Taylor (a2) (a3) and P. McGuire (a1)...
Abstract
Background

Paliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.

Methods

EHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.

Results

Patients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) −57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82).

Conclusion

Paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: R. Patel, Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Box PO 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. (Email: psycholmed@rpatel.co.uk)
References
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Alphs L, Benson C, Cheshire-Kinney K, Lindenmayer J-P, Mao L, Rodriguez SC, Starr HL (2015). Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia. Journal of Clinical Psychiatry 1, 554561.
Alphs L, Bossie CA, Sliwa JK, Ma Y-W, Turner N (2011). Onset of efficacy with acute long-acting injectable paliperidone palmitate treatment in markedly to severely ill patients with schizophrenia: post hoc analysis of a randomized, double-blind clinical trial. Annals of General Psychiatry 10(1), 12.
Ascher-Svanum H, Peng X, Faries D, Montgomery W, Haddad PM (2009). Treatment patterns and clinical characteristics prior to initiating depot typical antipsychotics for nonadherent schizophrenia patients. BMC Psychiatry 9, 46.
Attard A, Olofinjana O, Cornelius V, Curtis V, Taylor D (2014). Paliperidone palmitate long-acting injection--prospective year-long follow-up of use in clinical practice. Acta Psychiatrica Scandinavica 130, 4651.
Barnes TRE (2005). Why indeed?: Invited commentary on… Why aren't depot antipsychotics prescribed more often and what can be done about it? Advances in Psychiatric Treatment 11, 211213.
Berwaerts J, Liu Y, Gopal S, Nuamah I, Xu H, Savitz A, Coppola D, Schotte A, Remmerie B, Maruta N, Hough DW (2015). Efficacy and safety of the 3-month formulation of paliperidone palmitate vs placebo for relapse prevention of schizophrenia. JAMA Psychiatry 72, 830.
Bosanac P, Castle D (2015). Why are long-acting injectable antipsychotics still underused?. Advances in Psychiatric Treatment 21, 98105.
Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V (2014). The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Therapeutic Advances in Psychopharmacology 4, 198219.
Coppola D, Liu Y, Gopal S, Remmerie B, Samtani MN, Hough DW, Nuamah I, Sulaiman A, Pandina G (2012). A one-year prospective study of the safety, tolerability and pharmacokinetics of the highest available dose of paliperidone palmitate in patients with schizophrenia. BMC Psychiatry 12, 26.
Decuypere F, Sermon J, Geerts P, Denee TR, De Vos C, Malfait B, Lamotte M, Mulder CL (2017). Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: a retrospective database study. PLoS ONE 12, e0179049.
Fleischhacker WW, Gopal S, Lane R, Gassmann-Mayer C, Lim P, Hough D, Remmerie B, Eerdekens M (2012). A randomized trial of paliperidone palmitate and risperidone long-acting injectable in schizophrenia. International Journal of Neuropsychopharmacology 15, 107118.
Furukawa TA, Levine SZ, Tanaka S, Goldberg Y, Samara M, Davis JM, Cipriani A, Leucht S (2015). Initial severity of schizophrenia and efficacy of antipsychotics. JAMA Psychiatry 72, 14.
Haddad PM, Kishimoto T, Correll CU, Kane JM (2015). Ambiguous findings concerning potential advantages of depot antipsychotics. Current Opinion in Psychiatry 28, 216221.
Health and Social Care Information Centre (2016). Prescription Cost Analysis, England - 2015, NHS Digital.
Hough D, Gopal S, Vijapurkar U, Lim P, Morozova M, Eerdekens M (2010). Paliperidone palmitate maintenance treatment in delaying the time-to-relapse in patients with schizophrenia: a randomized, double-blind, placebo-controlled study. Schizophrenia Research 116, 107117.
Johnson DAW (2009). Historical perspective on antipsychotic long-acting injections . British Journal of Psychiatry 195, 713.
Kirson NY, Weiden PJ, Yermakov S, Huang W, Samuelson T, Offord SJ, Greenberg PE, Wong BJO (2013). Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. Journal of Clinical Psychiatry 74, 568575.
Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU (2013). Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies . Journal of Clinical Psychiatry 74, 957965.
Kishimoto T, Robenzadeh A, Leucht C, Leucht S, Watanabe K, Mimura M, Borenstein M, Kane JM, Correll CU (2014). Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophrenia Bulletin 40, 192213.
Kozma CM, Slaton T, Dirani R, Fastenau J, Gopal S, Hough D (2011). Changes in schizophrenia-related hospitalization and ER use among patients receiving paliperidone palmitate: results from a clinical trial with a 52-week open-label extension (OLE). Current Medical Research and Opinion 27, 16031611.
Kramer M, Litman R, Hough D, Lane R, Lim P, Liu Y, Eerdekens M (2010). Paliperidone palmitate, a potential long-acting treatment for patients with schizophrenia. Results of a randomized, double-blind, placebo-controlled efficacy and safety study. The International Journal of Neuropsychopharmacology 13, 635647.
Kramer M, Simpson G, Maciulis V, Kushner S, Vijapurkar U, Lim P, Eerdekens M (2007). Paliperidone extended-release tablets for prevention of symptom recurrence in patients with schizophrenia. Journal of Clinical Psychopharmacology 27, 614.
Leucht C, Heres S, Kane JM, Kissling W, Davis JM, Leucht S (2011). Oral versus depot antipsychotic drugs for schizophrenia-A critical systematic review and meta-analysis of randomised long-term trials. Schizophrenia Research 127, 8392.
Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. The Lancet 373, 3141.
Li H, Rui Q, Ning X, Xu H, Gu N (2011). A comparative study of paliperidone palmitate and risperidone long-acting injectable therapy in schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry 35, 10021008.
Marcus SC, Zummo J, Pettit AR, Stoddard J, Doshi JA (2015). Antipsychotic adherence and rehospitalization in schizophrenia patients receiving oral versus long-acting injectable antipsychotics following hospital discharge. Journal of Managed Care & Specialty Pharmacy 21, 754769.
Markowitz M, Fu D-J, Levitan B, Gopal S, Turkoz I, Alphs L (2013). Long-acting injectable paliperidone palmitate versus oral paliperidone extended release: a comparative analysis from two placebo-controlled relapse prevention studies. Annals of General Psychiatry 12, 22.
McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S (2008). Paying the Price: The Cost of Mental Health Care in England to 2026. The King's Fund.
McEvoy JP, Byerly M, Hamer RM, Dominik R, Swartz MS, Rosenheck RA, Ray N, Lamberti JS, Buckley PF, Wilkins TM, Stroup TS (2014). Effectiveness of paliperidone palmitate vs haloperidol decanoate for maintenance treatment of schizophrenia. Journal of the American Medical Association 311, 1978.
Mehnert A, Nicholl D, Pudas H, Martin M, McGuire A (2012). Cost effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Sweden. Journal of Medical Economics 15, 844861.
Muser E, Kozma CM, Benson CJ, Mao L, Starr HL, Alphs L, Fastenau J (2015). Cost effectiveness of paliperidone palmitate versus oral antipsychotics in patients with schizophrenia and a history of criminal justice involvement. Journal of Medical Economics 18, 637645.
Naber D, Hansen K, Forray C, Baker RA, Sapin C, Beillat M, Peters-Strickland T, Nylander AG, Hertel P, Andersen HS, Eramo A, Loze JY, Potkin SG (2015). Qualify: a randomized head-to-head study of aripiprazole once-monthly and paliperidone palmitate in the treatment of schizophrenia. Schizophrenia Research 168, 498504.
Pandina G, Lane R, Gopal S, Gassmann-Mayer C, Hough D, Remmerie B, Simpson G (2011). A double-blind study of paliperidone palmitate and risperidone long-acting injectable in adults with schizophrenia. Neuro-Psychopharmacology & Biological Psychiatry 35, 218226.
Patel R, Chesney E, Cullen AE, Tulloch AD, Broadbent M, Stewart R, McGuire P (2016a). Clinical outcomes and mortality associated with weekend admission to psychiatric hospital. British Journal of Psychiatry 209, 2934.
Patel R, Jayatilleke N, Broadbent M, Chang C-K, Foskett N, Gorrell G, Hayes RD, Jackson R, Johnston C, Shetty H, Roberts A, McGuire P, Stewart R (2015a). Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method. BMJ Open 5, 19, e007619.
Patel R, Lloyd T, Jackson R, Ball M, Shetty H, Broadbent M, Geddes JR, Stewart R, McGuire P, Taylor M (2015b). Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open 5, 19, e007504.
Patel R, Reiss P, Shetty H, Broadbent M, Stewart R, McGuire P, Taylor M (2015c). Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. BMJ Open 5, 16, e008341.
Patel R, Shetty H, Jackson R, Broadbent M, Stewart R, Boydell J, McGuire P, Taylor M (2015d). Delays before diagnosis and initiation of treatment in patients presenting to mental health services with bipolar disorder. PLoS ONE 10, 117, e0126530.
Patel R, Wilson R, Jackson R, Ball M, Shetty H, Broadbent M, Stewart R, McGuire P, Bhattacharyya S (2016b). Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open 6, 19, e009888.
Pinto R, Ashworth M, Seed P, Rowlands G, Schofield P, Jones R (2010). Differences in the primary care management of patients with psychosis from two ethnic groups: a population-based cross-sectional study. Family Practice 27, 439446.
Savitz AJ, Xu H, Gopal S, Nuamah I, Ravenstijn P, Janik A, Schotte A, Hough D, Fleischhacker WW (2016). Efficacy and safety of paliperidone palmitate 3-month formulation for patients with schizophrenia: a randomized, multicenter, double-blind, noninferiority study. International Journal of Neuropsychopharmacology 19, pyw018.
Schreiner A, Aadamsoo K, Altamura AC, Franco M, Gorwood P, Neznanov NG, Schronen J, Ucok A, Zink M, Janik A, Cherubin P, Lahaye M, Hargarter L (2015). Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia. Schizophrenia Research 169, 393399.
Taylor D, Olofinjana O (2014). Long-acting paliperidone palmitate – interim results of an observational study of its effect on hospitalization. International Clinical Psychopharmacology 29, 229234.
Taylor DM, Fischetti C, Sparshatt A, Thomas A, Bishara D, Cornelius V (2009). Risperidone long-acting injection: a prospective 3-year analysis of its use in clinical practice. Journal of Clinical Psychiatry 70, 196200.
Tiihonen J, Haukka J, Taylor M, Haddad PM, Patel MX, Korhonen P (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry 168, 603609.
Voss EA, Ryan PB, Stang PE, Hough D, Alphs L (2015). Switching from risperidone long-acting injectable to paliperidone long-acting injectable or oral antipsychotics. International Clinical Psychopharmacology 30, 151157.
Zeidler J, Mahlich J, Greiner W, Heres S (2013). Cost effectiveness of paliperidone palmitate for the treatment of schizophrenia in Germany. Applied Health Economics and Health Policy 11, 509521.
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