Paliperidone palmitate initiation tied to higher treatment continuation in schizophrenia: BMC

Europe: In schizophrenia patients, paliperidone palmitate is associated with a significantly higher treatment continuation than risperidone microspheres, states an article in BMC Psychiatry.

Schizophrenia is a serious, chronic mental disorder that requires lifelong treatment, even during the period of remission. Despite a good response to antipsychotic medications, its discontinuation rate is high, which often leads to relapse and rehospitalization and increased disease severity and medical resource use. Regarding medication continuation, long-acting antipsychotic treatment (e.g. 1-monthly (PP1M) / 3-monthly (PP3M) injection forms of paliperidone palmitate) offers an important alternative to oral APs. Even though the side effects of antipsychotics (diabetes, weight gain, cardiovascular disease, reduced brain volume, tardive dyskinesia, and sexual dysfunction) are an important cause of discontinuation and one-third of patients with schizophrenia are unresponsive to medications, the most common cause of discontinuation is poor self-perception of the treatment response and inadequate understanding of the disease course.

Rui Cai Real World Evidence, IQVIA, Belgium, and her colleagues from France and Germany aimed to assess risk factors of treatment discontinuation in patients on paliperidone palmitate and risperidone microsphere. They also compared treatment discontinuation between patients with PP1M and PP3M.

Risk factors for anti-psychotic treatment discontinuation over a 1-year follow-up period were identified among 25,361 patients with schizophrenia patients (France: 9,720; Germany: 14,461; Belgium: 1,180) enrolled in the IQVIA Longitudinal Prescription database.

Key findings of the study,

• Significant lower treatment discontinuation was observed for patients newly initiated on paliperidone palmitate (53.8%) than those on risperidone microspheres (85.4%)

• Significantly lower treatment discontinuation was found for 'stable' PP3M patients (19.2%) than 'stable' PP1M patients (37.1%).

• Higher discontinuation rates were observed when the medication was prescribed by a GP than a psychiatrist (HR = 1.68). Discontinuation rates were higher for females (HR = 1.07) and for patients < 30 years of age (HR = 1.05-1.09)

The authors conclude that the patients stay significantly longer on treatment when initiated on paliperidone palmitate as compared to risperidone microspheres. The study indicated a higher treatment continuation of PP3M over PP1M. Treatment continuation is can be improved by empowering GPs with mental health knowledge and managing patients with a collaborative primary care-mental health model.

The reason behind more treatment discontinuation among female patients needs to be researched further, the authors wrote.

Reference: 

Cai, R., Decuypere, F., Chevalier, P. et al. Assessment of risk factors of treatment discontinuation among patients on paliperidone palmitate and risperidone microspheres in France, Germany and Belgium. BMC Psychiatry 22, 382 (2022). https://doi.org/10.1186/s12888-022-03914-2