Abstract
Introduction: Paliperidone and aripiprazole long-acting injections (PLAI and ALAI) were recommended as treatment options for schizophrenia in NHS Wales by the All Wales Medicines Strategy Group (AWMSG) in 2012 and 2014 respectively. The aim of the present study was to assess the effectiveness of PLAI or ALAI in a real world setting using treatment continuation at six months as an outcome measure.
Method: All patients from a single health board in Wales who were initiated on PLAI or ALAI in the nine months following the publication of respective AWMSG advice were identified from pharmacy records. Demographic factors which may have influenced outcome were analysed, and reasons for treatment discontinuation noted. Previous treatment with clozapine was considered an indicator of treatment refractory illness. Data were collected by retrospective case-note review.
Results: Twenty-eight patients received PLAI, of whom two were lost to follow-up, and 26 patients received ALAI. Therefore, six month outcome data were available for 52 patients. Seven (27%) PLAI and 12 (46%) ALAI treated patients received the medication for indications other than schizophrenia (p=0.25 Fisher’s Exact Test). Twenty two (85%) and 19 (73%) patients remained on PLAI and ALAI respectively at six months (p=0.50, Fisher’s exact test). Treatment continuation with either drug was not associated with diagnosis, age at initiation, or inpatient/outpatient status on initiation. Three patients treated with PLAI and one patient treated with ALAI had previously received clozapine. The most common reason for discontinuation of PLAI was perceived lack of effect (n=3; 75%), whilst reasons for ALAI discontinuation included perceived lack of effect (n=2), adverse effects (n=2) and patient choice (n=2).
Conclusions: There were no statistically significant differences in the demographics of the patients receiving each of the two drugs. The proportion of patients remaining on each treatment was comparable to that reported at the six month time-point of a one year naturalistic study of PLAI (Attard et al. Acta Psychiatrica Scand 2014; 130:46–51). In contrast to the study of Attard et al (2014), inpatient status on initiation did not appear to influence treatment continuation at six months, although patient numbers were small. Prescribing outside of the product license accounted for 37% of patients. In part, this perhaps reflects the more limited indications of these long-acting injectable preparations compared to their oral equivalents. However, it also highlights the relatively common phenomenon of off-label prescribing within the field of psychiatry.
Method: All patients from a single health board in Wales who were initiated on PLAI or ALAI in the nine months following the publication of respective AWMSG advice were identified from pharmacy records. Demographic factors which may have influenced outcome were analysed, and reasons for treatment discontinuation noted. Previous treatment with clozapine was considered an indicator of treatment refractory illness. Data were collected by retrospective case-note review.
Results: Twenty-eight patients received PLAI, of whom two were lost to follow-up, and 26 patients received ALAI. Therefore, six month outcome data were available for 52 patients. Seven (27%) PLAI and 12 (46%) ALAI treated patients received the medication for indications other than schizophrenia (p=0.25 Fisher’s Exact Test). Twenty two (85%) and 19 (73%) patients remained on PLAI and ALAI respectively at six months (p=0.50, Fisher’s exact test). Treatment continuation with either drug was not associated with diagnosis, age at initiation, or inpatient/outpatient status on initiation. Three patients treated with PLAI and one patient treated with ALAI had previously received clozapine. The most common reason for discontinuation of PLAI was perceived lack of effect (n=3; 75%), whilst reasons for ALAI discontinuation included perceived lack of effect (n=2), adverse effects (n=2) and patient choice (n=2).
Conclusions: There were no statistically significant differences in the demographics of the patients receiving each of the two drugs. The proportion of patients remaining on each treatment was comparable to that reported at the six month time-point of a one year naturalistic study of PLAI (Attard et al. Acta Psychiatrica Scand 2014; 130:46–51). In contrast to the study of Attard et al (2014), inpatient status on initiation did not appear to influence treatment continuation at six months, although patient numbers were small. Prescribing outside of the product license accounted for 37% of patients. In part, this perhaps reflects the more limited indications of these long-acting injectable preparations compared to their oral equivalents. However, it also highlights the relatively common phenomenon of off-label prescribing within the field of psychiatry.
| Original language | English |
|---|---|
| Pages | A28-A29 |
| Number of pages | 1 |
| Publication status | Published - Aug 2016 |