Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization

Figures & data

Figure 1. Patient selection criteria for 12-months pre- and post-PP1M pransition among VHA patients with schizophrenia and ≥1 prior hospitalization. Abbreviations. ICD-9/10-CM, International Classification of Diseases—Ninth/Tenth Revision—Clinical Modification; oral ris/pali, oral risperidone or paliperidone; PP1M, once-monthly paliperidone palmitate; VHA, Veterans Health Administration.

Table 1. Demographic and baseline clinical characteristics of PP1M VHA patients with schizophrenia and prior hospitalization.

Baseline characteristics	Oral ris/pali users transitioning to PP1M (6 months) (n = 401)	Oral ris/pali users transitioning to PP1M (12 months) (n = 319)
	n (%)	n (%)
Mean age (years), mean ± SD	50.6 ± 13.9	51.6 ± 14.2
Age (years)
18–34	75 (18.7%)	52 (16.3%)
35–44	63 (15.7%)	50 (15.7%)
45–54	57 (14.2%)	42 (13.2%)
55–64	143 (35.7)	116 (36.4%)
≥65	63 (15.7%)	59 (18.5%)
Sex
Male	368 (91.8%)	290 (90.9%)
Race
White	197 (49.1%)	155 (48.6%)
Black	154 (38.4%)	124 (38.9%)
Other and unknown	50 (12.5%)	40 (12.5%)
Comorbid condition (mean ± SD)
Quan-Charlson comorbidity index score	0.9 ± 1.4	1.1 ± 1.6
Mental health-related comorbidities
Post-traumatic stress disorder	105 (26.2%)	90 (28.2%)
Personality disorder	40 (10.0%)	52 (16.3%)
Anxiety	94 (23.4%)	100 (31.4%)
Suicide attempt and intentional injuries	45 (11.2%)	39 (12.2%)
Tobacco use	215 (53.6%)	178 (55.8%)
Bipolar disorder	91 (22.7%)	92 (28.8%)
Any depressive disorder	196 (48.9%)	188 (58.9%)
Substance abuse	231 (57.6%)	195 (61.1%)
Non-mental health-related comorbidities
Obesity	77 (19.2%)	78 (24.5%)
Diabetes mellitus	85 (21.2%)	78 (24.5%)
Cardiovascular disease – hyperlipidemia	148 (36.9%)	142 (44.5%)
Cardiovascular disease – hypertension	188 (46.9%)	159 (49.8%)
Cardiovascular disease – coronary artery disease	22 (5.5%)	18 (5.6%)
Hepatitis C	22 (5.5%)	24 (7.5%)
Chronic obstructive pulmonary disease	62 (15.5%)	64 (20.1%)

Abbreviations. CVD, cardiovascular disease; oral ris/pali, oral risperidone or paliperidone; PP1M, once-monthly paliperidone palmitate; SD, standard deviation; VHA, Veterans Health Administration.

Table 2. Comparison of treatment patterns 12-months and 6-months pre- and post-PP1M transition among VHA patients with schizophrenia treated with oral Ris/pali.

Treatment patterns 12-months pre- and post-PP1M transition	6-months pre-PP1M transition (n = 401)	6-months post-PP1M transition (n = 401)	p-value*	12-months pre-PP1M transition (n = 319)	12-months post-PP1M transition (n = 319)	p-value*
	n (%)	n (%)		n (%)	n (%)
AP use
Any oral APs	401 (100%)	244 (60.8%)	—	319 (100%)	226 (70.8%)	—
Atypical oral Aps	401 (100%)	240 (59.9%)	—	319 (100%)	220 (69.0%)	—
Any LAI APs	90 (22.4%)	401 (100%)	—	76 (23.8%)	319 (100%)	—
Atypical LAI Aps	71 (17.7%)	401 (100%)	—	60 (18.8%)	319 (100%)	—
Antidepressants	259 (64.6%)	243 (60.6%)	.0772	225 (70.5%)	213 (66.8%)	.1336
Anxiolytics	220 (54.9%)	206 (51.4%)	.1487	197 (61.8%)	186 (58.3%)	.1917
Mood Stabilizers	205 (51.1%)	191 (47.6%)	.0660	188 (58.9%)	169 (53.0%)	.0104*
PDC
PDC by any agent,
Mean ± SD [Median]	0.5 ± 0.3 [0.5]	0.8 ± 0.3 [0.9]	<.0001*	0.5 ± 0.3 [0.6]	0.7 ± 0.3 [0.8]	<.0001*
≥80%	107 (26.7%)	246 (61.3%)	<.0001*	74 (23.2%)	168 (52.7%)	.0679
PDC by Oral ris/pali,
Mean ± SD [Median]	0.4 ± 0.3 [0.3]	0.3 ± 0.4 [0.0]	<.0001*	0.3 ± 0.3 [0.2]	0.2 ± 0.3 [0.0]	<.0001*
≥80%	50 (12.5%)	23 (5.7%)	.0007*	23 (7.2%)	13 (4.1%)	<.0001*
PDC by PP1M
Mean ± SD [Median]	—	0.6 ± 0.3 [0.7]	—	—	0.5 ± 0.3 [0.5]	—
≥80%		163 (40.6%)	—		88 (27.6%)	—
MPR
MPR by any agent
Mean ± SD [Median]	0.6 ± 0.3 [0.7]	0.9 ± 0.2 [1.0]	<.0001*	0.7 ± 0.3 [0.7]	0.8 ± 0.3 [1.0]	<.0001*
≥80%	178 (44.4%)	316 (78.8%)	<.0001*	141 (44.2%)	232 (72.7%)	<.0001*
MPR by Oral ris/pali
Mean ± SD [Median]	0.4 ± 0.3 [0.3]	0.3 ± 0.3 [0.0]	<.0001*	0.4 ± 0.3 [0.2]	0.2 ± 0.3 [0.1]	<.0001*
≥80%	83 (20.7%)	68 (17.0%)	.1432	62 (19.4%)	41 (12.9%)	.0167
MPR by PP1M
Mean ± SD [Median]	—	0.7 ± 0.4 [0.8]	—	—	0.6 ± 0.4 [0.5]	—
≥80%		202 (50.4%)	—		118 (37.0%)	—

* Significant at p < .05.

Abbreviations. AP, antipsychotic; LAI, long-acting injectable; MPR, medication possession ratio; Oral ris/pali, oral risperidone or paliperidone; PDC, proportion of days covered; PP1M, once-monthly paliperidone palmitate; SD, standard deviation; VHA, Veterans Health Administration.

Figure 2. Comparison of all-cause HRU (a) 6-months, and (b) 12-months pre- and post-PP1M transition among VHA patients with schizophrenia treated with oral ris/pali. *Significant at p < .05. Abbreviations. HRU, healthcare resource utilization; oral ris/pali, oral risperidone or paliperidone; PP1M, once-monthly paliperidone palmitate; VHA, Veterans Health Administration.

Figure 3. Comparison of all-cause healthcare costs (a) 6-month, and (b) 12-month pre- and post-PP1M transition among VHA patients with schizophrenia treated with oral ris/pali. *Significant at p < .05. Abbreviations. ris/pali, risperidone or paliperidone; PP1M, once-monthly paliperidone palmitate; VHA, Veterans Health Administration.