Factors predicting relapse and treatment discontinuation with paliperidone 3-monthly long-acting injection: A 2-year naturalistic follow-up study |
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Authors: | Ivana Clark Phoebe Wallman Victoria Cornelius David Taylor |
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Institution: | 1.Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK ; 2.School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK ; 3. Institute of Pharmaceutical Science, King’s College, 5th Floor, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK |
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Abstract: | BackgroundPaliperidone 3-monthly (PP3M) long-acting injection has proven efficacy and effectiveness in schizophrenia. Little is known of its effectiveness in other diagnoses.MethodsAll patients starting PP3M were followed up for 2 years. Main outcome measures were relapse and discontinuation from PP3M. Post hoc we examined outcomes in those switched back to one monthly paliperidone (PP1M) long-acting injection.ResultsOverall, 186 patients were followed-up. At the 2-year end point, 110 patients (59%) were still receiving PP3M, and 129 (70%) were receiving some form of paliperidone long-acting injection. Discontinuation from paliperidone long-acting injections (PPLAIs) was more likely with a nonschizophrenia diagnosis (hazard ratio HR] for continuation 0.429 95% confidence intervals (CI) – 0.21, 0.87 p = 0.018)), and prior clozapine use in PP3M patients; HR for discontinuation 1.87 95% CI – 1.05, 3.30 p = 0.032]). Relapse occurred in 20 (11%) of those receiving PP3M. Relapse on PP3M and PPLAIs was more likely in nonschizophrenia diagnosis (HR 0.17 for remaining relapse-free 95% CI – 0.06, 0.50; p = 0.001]; HR 0.21 95% CI – 0.08, 0.58 p = 0.002], respectively), polypharmacy in PP3M patients (HR for relapse 7.91 95% CI – 3.73, 22.9; p < 0.001]) and PPLAI patients (HR for relapse 6.45 95% CI – 2.49, 16.5; p < 0.001]), and prior clozapine use in PP3M patients (HR for relapse 6.11 95% CI – 1.82, 20.5; p = 0.003]) and PPLAI patients (HR for relapse 4.52 (95% CI – 1.51, 13.5; p = 0.007).ConclusionsOutcomes with PP3M are excellent in practice, even when used outside its formal license. PP3M was relatively more effective in those with an F20 schizophrenia diagnosis and in those never before considered for or prescribed clozapine. |
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Keywords: | discontinuation paliperidone psychotic disorders relapse three monthly |
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