Paliperidone Palmitate: A Breakthrough Treatment for Schizophrenia? A Review on Patient Adherence Levels, Healthcare Resource Utilization and Costs

Figures & data

Table 1 Differences Between Adherence Patterns Among Patients Treated with Paliperidone Palmitate and Oral Antipsychotics: Results from Observational Studies, Using PDC as a Measure of Compliance

Authors	Study Design	Sample (N)	Treatment	Adherence
Campagna et al, 2014^Citation29	Retrospective Cohort Study	LAI: 195 OA: 369	PP1M Aripiprazole	PDC mean PP1M: Data as received: 0.59 Derived Days-30 days: 0.61 Derived Days −28 days: 0.58 Covered Days: 0.55 OA: 0.37 PDC ≥80% PP1M: Data as received: 36.4% Derived Days-30:37.9% Derived Days −28:35.4% Covered Days: 27.2% OA: 25.2%	p=0.003 p<0.001 p<0.001 p=0.0039 p<0.005 p=0.002 p<0.011 p=0.610
Young-Xu et al, 2016^Citation31	Retrospective Cohort Study	LAI: 5052 OA:5238	PP1M Aripiprazolo, Asenapine, Iloperidone, Lurasidone, Olanzapine, Quetiapine, Risperidone, Ziprasidone Paliperidone.	PDC≥ 80% PP1M: 35.8% OA: 23.3%	p<0.001
Greene et al, 2018^Citation32	Retrospective Cohort Study	LAI: 2861 OA: 2777	Aripiprazole Monohydrate, Fluphenazine Decanoate, Haloperidol Decanoate, Olanzapine Pamoate, PP1M, Risperidone Microspheres. Quetiapine, Risperidone, Olanzapine, Lurasidone, Aripiprazole, Ziprasidone, Haloperidol, Paliperidone.	PDC mean PP1M: 0.55 OA: 0.50 PDC≥80% PP1M: 33.9% OA: 25.5%	p<0.001 p<0.001
Pilon et al, 2017^Citation35	Retrospective Cohort Study	LAI: 3307 OA: 21,355	PP1M, Aripiprazole, Risperidone, Olanzapine. Aripiprazole, Asenapine, Iloperidone, Lurasidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Ziprasidone.	PDC mean PP1M: 0.55 OA: 0.53 PDC≥80% PP1M: 31.1% OA: 28.1%	p<0.001 p<0.001
Pesa et al, 2017^Citation33	Retrospective Cohort Study	LAI: 1939 OA: 3786	PP1M Aripiprazole, Asenapine, Iloperidone, Lurasidone, Olanzapine, Paliperidone	PDC mean PP1M: 0.7 OA: 0.6	p<0.001
Anderson et al, 2017^Citation28	Retrospective Cohort Study	LAI: 482 OA: 281	PP1M Atypical Antipsychotics	PDC mean PP-N+PP-C: 0.57 OA: 0.31 PP-N: 0.53 OA: 0.31 PDC ≥80% PP-N+PP-C: 44% OA: 9% PP-N: 39% OA: 9% Predictors of PDC ≥80% PP1M initiation: OR 10.3 PP1M continuation: OR 16.5 Older age: OR 1.3 History of arrest: OR 4.2 Private residence OR 1.9 White race OR 2.5 Heart Disease OR 3.4 No history of substance abuse OR 2.3	p<0.001 p<0.001 p<0.001 p<0.001 p<0.001 p<0.001 p=0.028 p=0.031 p=0.012 p<0.001 p=0.010 p<0.001
Joshi et al, 2018^Citation36	Retrospective Cohort Study	LAI: 295 OA: 2296	PP1M Aripiprazole, Asenapine, Iloperidone, Lurasidone Olanzapine, Paliperidone, Quetiapine, Ziprasidone	PDC mean PP1M: 0.66 OA: 0.57	p<0.001
El Khoury et al, 2019^Citation37	Mirror Study (12 months pre/post PP1M) (6 months pre/post PP1M)	− 6 months: 401 –12 months: 319	PP1M Risperidone, Paliperidone	PDC mean 6 months Pre PP1M: 0.4 Post PP1M: 0.6 12 months Pre PP1M: 0.3 Post PP1M: 0.5 PDC ≥80% 6 months Pre PP1M: 12.5% Post PP1M: 40.6% 12 months Pre PP1M: 7.2% Post PP1M: 27.6%	p<0.001 p<0.001 p=0.0007 p<0.001
Patel et al, 2021^Citation30	Retrospective Cohort Study	LAI: 208 OA: 624	PP1M Atypical Antipsychotics	PDC mean After 6 months PP1M: 0.53 OA: 0.46 After 12 months PP1M: 0.41 OA: 0.34	p=0.0013 p=0.008
Wang et al, 2021^Citation34	Retrospective Cohort Study	JMDC LAI: 249 OA: 40,058 PKU LAI: 428 OA: 6450 XJH LAI: 189 OA: 3884	PP1M Atypical Antipsychotics	PDC ≥80% JMDC PP1M: 66% OA: 52% MPKU PP1M: 36% OA:19% XJH PP1M:35% OA:15% ODD of having PDC ≥80% (LAI) JMDC PP1M: OR 1.61 PKU PP1M: OR 1.92 XJH PP1M: OR 2.25	p< 0.01 p< 0.01 p<0.01 p<0.01 p<0.01 p<0.01

Abbreviations: PP1M: Paliperidone Palmitate Once Monthly; OA: Oral Antipsychotic; LAI: Long Acting Injectable; PP-N: Paliperidone Palmitate-New; PP-C: Paliperidone Palmitate-Continued. PDC: Proportion of Days Covered; JMDC: Japan Medical Data Center; PKU: Peking University No.6 Hospital; XJH: Xijing Hospital.

Figure 1 Flow diagram of the systematic review.

Campagna EJ, Muser E, Parks J, Morrato EH. Methodological considerations in estimating adherence and persistence for a long-acting injectable medication. J Manag Care Spec Pharm. 2014;20(7):756–766. PMID: 24967528. doi:10.18553/jmcp.2014.20.7.756

 PubMed Web of Science ®Google Scholar

Young-Xu Y, Duh MS, Muser E, et al. Impact of paliperidone palmitate versus oral atypical antipsychotics on health care resource use and costs in veterans with schizophrenia. J Clin Psychiatry. 2016;77(10):e1332–e1341. PMID: 27574835. doi:10.4088/JCP.16m10745

 PubMed Web of Science ®Google Scholar

Greene M, Yan T, Chang E, Hartry A, Touya M, Broder MS. Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder. J Med Econ. 2018;21(2):127–134. PMID: 28895758. doi:10.1080/13696998.2017.1379412

 PubMed Web of Science ®Google Scholar

Pilon D, Tandon N, Lafeuille MH, et al. Treatment patterns, health care resource utilization, and spending in Medicaid beneficiaries initiating second-generation long-acting injectable agents versus oral atypical antipsychotics. Clin Ther. 2017;39(10):1972–1985.e2; PMID: 28919292. doi: 10.1016/j.clinthera.2017.08.008

 PubMed Web of Science ®Google Scholar

Pesa JA, Doshi D, Wang L, Yuce H, Baser O. Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment. Curr Med Res Opin. 2017;33(4):723–731. PMID: 28044455. doi:10.1080/03007995.2016.1278202

 PubMed Web of Science ®Google Scholar

Anderson JP, Icten Z, Alas V, Benson C, Joshi K. Comparison and predictors of treatment adherence and remission among patients with schizophrenia treated with paliperidone palmitate or atypical oral antipsychotics in community behavioral health organizations. BMC Psychiatry. 2017;17(1):346. PMID: 29047368; PMCID: PMC5648472. doi:10.1186/s12888-017-1507-8

 PubMedGoogle Scholar

Joshi K, Muser E, Xu Y, Schwab P, Datar M, Suehs B. Adherence and economic impact of paliperidone palmitate versus oral atypical antipsychotics in a Medicare population. J Comp Eff Res. 2018;7(8):723–735. PMID: 29722547. doi:10.2217/cer-2018-0003

 PubMed Web of Science ®Google Scholar

El Khoury A, Patel C, Huang A, Wang L, Bashyal R. 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. Curr Med Res Opin. 2019;35(12):2159–2168. PMID: 31366251. doi:10.1080/03007995.2019.1651129

 PubMed Web of Science ®Google Scholar

Patel C, Emond B, Morrison L, et al. Risk of subsequent relapses and corresponding healthcare costs among recently-relapsed Medicaid patients with schizophrenia: a real-world retrospective cohort study. Curr Med Res Opin. 2021;37(4):665–674; PMID: 33507831. doi: 10.1080/03007995.2021.1882977

 PubMed Web of Science ®Google Scholar

Wang H, Zhang Y, Liu J, et al. Persistence with and adherence to paliperidone palmitate once-monthly injection for schizophrenia treatment in China and Japan. J Clin Psychiatry. 2021;83(1):13850. PMID: 34963203. doi:10.4088/JCP.20m13850

 Web of Science ®Google Scholar