Practical guidelines on the use of paliperidone palmitate in schizophrenia

Abstract

Objective:

Paliperidone palmitate is an atypical long-acting injectable (LAI) antipsychotic that has been approved for use in the US, EU, Australia and numerous other countries for acute and maintenance therapy of schizophrenia.

LAI antipsychotics are often viewed as a ‘last-resort’ treatment for difficult-to-treat patients, however this article considers their role more broadly in the management of partial or non-adherence in schizophrenia.

Method:

A search of MedLine, CTR and PsychInfo was conducted to identify relevant publications and clinical trials (search term ‘paliperidone palmitate’, up to December 2010). The findings were discussed in a number of teleconferences and the manuscript was finalized with a face-to-face meeting of the authors group.

Main findings:

Relapse prevention in schizophrenia requires a comprehensive approach to treatment, which includes antipsychotic medication and psychosocial measures as well as family and/or carer involvement. Good symptom control and the interconnected issue of treatment adherence are arguably the most crucial factors for success. Carer and patient feedback should be carefully considered. Negotiation about commencing LAI therapy done early in course of disease is easier than many clinicians believe, although it is not often attempted in practice. Paliperidone palmitate is useful in both the acute and maintenance phases of treatment.

Commentary:

A case-based approach is presented to suggest various opportunities where use of paliperidone palmitate could be considered within the disease course of schizophrenia.

Conclusions:

Paliperidone palmitate offers some advantages in terms of tolerability, simplicity of treatment initiation and long duration between injections. The consensus of the authors is that rather than reserving paliperidone palmitate for use in difficult-to-treat or refractory patients, it could be used to promote adherence and prevent relapse earlier in the course of the illness.

Keywords::

• Long-acting injectable antipsychotic
• Paliperidone palmitate

Transparency

Declaration of funding

Funding for writing group meetings (i.e., travel and meeting costs) was provided by Janssen Cilag Pty Ltd.

Declaration of financial/other relationships

H.H., R.L., J.L., B.M. and R.P. took part in a Product Familiarisation Program in accordance with the Medicines Australia Code of Practice and as part of this program were provided with limited quantities of paliperidone palmitate free of charge by Janssen Cilag Pty Limited.

B.M. has disclosed that he is a consultant to Janssen Cilag and is on the steering committee for the company’s educational group. He has also received grants from Janssen. R.P. has disclosed receiving sponsorship from Janssen Cilag. R.N. has disclosed that he has been sponsored by Janssen Cilag and is a consultant to and on the speaker’s bureau of Janssen, Eli Lilly, Astra Zeneca and Lundbeck. A.S. has disclosed that he is an employee of Janssen Cilag and holds stock in Johnson & Johnson. H.H. has disclosed that he has received sponsorship and grants from Janssen Cilag and is a consultant to and on the speaker’s bureau of Janssen, Eli Lilly, Pfizer, Wyeth, Astra Zeneca, and Servier. He is also an advisor to Lundbeck, Janssen and Pfizer. J.L. has disclosed that he received sponsorship from Janssen Cilag and funding for grant research and consultancy from Janssen and Eli Lilly. P.D.N. has disclosed receiving sponsorship from Janssen Cilag and Servier, is a consultant to Janssen, Eli Lilly, Lundbeck and Novartis and is on Lilly’s speaker’s bureau. R.L. has disclosed that he is a consultant to Eli Lilly and Janssen Cilag, and is on the speaker’s bureau of Eli Lilly, Janssen, and Astra Zeneca. CMRO peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors thank Naomi Adam from Allori Pty Limited for medical writing support, which was funded by Janssen Cilag Pty.