Long term impact of 3-monthly paliperidone palmitate on hospitalisation in patients with schizophrenia: Six-year mirror image study

IF 5.3 2区 医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-04-15 DOI:10.1111/acps.13691
Ivana Clark, Phoebe Wallman, Siobhan Gee, David Taylor
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Full details of methods used have been previously described.<span><sup>1</sup></span> The same patient cohort as previously defined was followed up for additional 12 months.</p><p>As before, 76 patients met inclusion criteria. Of this total baseline cohort, 52 patients (68%) continued on PPLAIs for 36 months, 19 patients (25%) discontinued within 36 months of initiation and 5 patients (7%) were lost to follow-up. The mean age on PPLAI initiation was 42 years; 54 were male. The majority of our baseline cohort was initiated on PP1M as inpatients (<i>n</i> = 49, 69%). Ethnicity breakdown was as follows: Asian (<i>n</i> = 4), Black (<i>n</i> = 44), Mixed background (<i>n</i> = 4), Other (<i>n</i> = 2), White (<i>n</i> = 17). On average, patients received PP1M for 10 months before starting PP3M. The most commonly prescribed maintenance dose was 100 mg a month (<i>n</i> = 31 [44%]) followed by 150 mg (<i>n</i> = 25, 35%), 75 mg (<i>n</i> = 12, 17%) and 50 mg (<i>n</i> = 3, 4%). From the original 76 starters, 19 patients discontinued over 36 months, for the following reasons: patient refusal (<i>n</i> = 10), perceived inefficacy (<i>n</i> = 5), unrelated health condition (‘kidney problems’ [<i>n</i> = 1] and cancer [<i>n</i> = 1]) and adverse effects (weight gain [<i>n</i> = 1] and raised liver function tests [<i>n</i> = 1]).</p><p>In those continuing on PPLAI for 3 years (<i>n</i> = 52), the mean number of admissions per year was 0.53 (SD 0.49) before PPLAI initiation and 0.01 (SD 0.06) (<i>p</i> &lt; 0.001) afterwards. The mean number of bed days a year was 31.3 days (SD 48.8) before PPLAI and 12.4 days (SD 23.6) (<i>p</i> &lt; 0.001) after. The majority of the bed days recorded in the period after PPLAI was started were from the index admission. Only two patients registered bed days after initiation (discounting the initial admission bed days). Both patients started PPLAI as inpatients. 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Abstract

Long-acting antipsychotics are accepted to be more effective than oral antipsychotics in reducing the risk of hospitalisation and relapse in schizophrenia. In our previous 5-year mirror-image study, we reported a significant reduction in hospital admissions and fewer days spent in hospital for people prescribed 3-monthly paliperidone (PP3M) after stabilisation on 1-monthly (PP1M).1 We now report the outcomes of the sixth year of this study.

Our primary objective was to use a mirror image model to evaluate hospital admissions and bed days before and after the initiation of PP1M followed by PP3M in those who continued treatment for 3 years. Full details of methods used have been previously described.1 The same patient cohort as previously defined was followed up for additional 12 months.

As before, 76 patients met inclusion criteria. Of this total baseline cohort, 52 patients (68%) continued on PPLAIs for 36 months, 19 patients (25%) discontinued within 36 months of initiation and 5 patients (7%) were lost to follow-up. The mean age on PPLAI initiation was 42 years; 54 were male. The majority of our baseline cohort was initiated on PP1M as inpatients (n = 49, 69%). Ethnicity breakdown was as follows: Asian (n = 4), Black (n = 44), Mixed background (n = 4), Other (n = 2), White (n = 17). On average, patients received PP1M for 10 months before starting PP3M. The most commonly prescribed maintenance dose was 100 mg a month (n = 31 [44%]) followed by 150 mg (n = 25, 35%), 75 mg (n = 12, 17%) and 50 mg (n = 3, 4%). From the original 76 starters, 19 patients discontinued over 36 months, for the following reasons: patient refusal (n = 10), perceived inefficacy (n = 5), unrelated health condition (‘kidney problems’ [n = 1] and cancer [n = 1]) and adverse effects (weight gain [n = 1] and raised liver function tests [n = 1]).

In those continuing on PPLAI for 3 years (n = 52), the mean number of admissions per year was 0.53 (SD 0.49) before PPLAI initiation and 0.01 (SD 0.06) (p < 0.001) afterwards. The mean number of bed days a year was 31.3 days (SD 48.8) before PPLAI and 12.4 days (SD 23.6) (p < 0.001) after. The majority of the bed days recorded in the period after PPLAI was started were from the index admission. Only two patients registered bed days after initiation (discounting the initial admission bed days). Both patients started PPLAI as inpatients. No patient starting PPLAI as an out-patient had bed days in the 3 years after initiation.

The use of PP3M after stabilisation on PP1M was associated with a considerable reduction in bed days and hospital admissions. During the observational period, only 8 of 71 patients started on PP1M/3 M (9.9%) were admitted to hospital. The majority of our patient cohort (80%) had been admitted to hospital at least once in the 3 years before starting PP1M. The mean number of admissions per year decreased by 98% in those continuing for 3 years. There were no admissions to the hospital in people continuing on PP3M for the last 18 months of the observational period. This is remarkable outcome when one considers that these patients were so frequently hospitalised before switching to PP3M.

The average number of bed days per year after the initiation of PPLAIs was reduced by more than half but a significant proportion of bed days recorded after starting PP1M was attributed to the initial or index admission. Patients who remained on treatment throughout the observational period showed a steady decrease in bed days, reaching zero days by the third year of treatment (mean bed days fell from 39.8 in year 1 to 0.63 in year 2 and to 0.0 in year 3) (Figure 1). The absence of bed days in the third year for continuers indicates that assured delivery of effective antipsychotic treatment can effectively reduce the risk of psychotic relapse to zero.

In the United Kingdom, the average annual cost of a standard bed is £125,925.2 In this study, the mean number of days spent in hospital reduced by an average 18.9 days/person/year for those continuing. This equates to cost savings £6521 per year. The yearly cost for the maximum dose of PP3M (525 mg) is £4711.3 However, the majority of our cohort were prescribed 350 mg PP3M. Using the cost for this dose net yearly savings were £2752. It is also important to highlight the additional benefits of less frequent administration such as a reduction in staff time devoted to injection procedures, increased patient activity and involvement in the community, improved social relationships and decreased feeling of stigma owing to schizophrenia diagnosis.4

DT reports research funding from Janssen and speaker's honoraria from Janssen, Otsuka, Viatris and Recordati. IC, PW and SG declare none.

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帕潘立酮棕榈酸酯(3个月一次)对精神分裂症患者住院治疗的长期影响:为期六年的镜像研究
在降低精神分裂症患者住院和复发风险方面,长效抗精神病药物被认为比口服抗精神病药物更有效。我们的主要目标是使用镜像模型来评估在开始使用帕利哌酮(PP1M)并随后使用帕利哌酮(PP3M)的患者中,持续治疗 3 年的患者在开始使用帕利哌酮(PP1M)并随后使用帕利哌酮(PP3M)前后的入院率和住院天数。与之前一样,76 名患者符合纳入标准。在所有基线组群中,52 名患者(68%)继续使用 PPLAIs 治疗 36 个月,19 名患者(25%)在开始治疗后 36 个月内停药,5 名患者(7%)失去随访机会。开始使用 PPLAI 的平均年龄为 42 岁,其中 54 人为男性。我们的基线队列中,大多数患者是作为住院患者开始使用 PP1M 的(n = 49,69%)。种族分布如下亚裔(4 人)、黑人(44 人)、混血(4 人)、其他(2 人)、白人(17 人)。在开始使用 PP3M 之前,患者平均接受了 10 个月的 PP1M 治疗。最常见的处方维持剂量是每月 100 毫克(31 人[44%]),其次是 150 毫克(25 人,35%)、75 毫克(12 人,17%)和 50 毫克(3 人,4%)。在最初的 76 名启动者中,有 19 名患者在 36 个月内停药,原因如下:患者拒绝(10 人)、认为无效(5 人)、与健康状况无关("肾脏问题"[1 人] 和癌症[1 人])以及不良反应(体重增加[1 人]和肝功能检测升高[1 人])。在持续使用 PPLAI 3 年的患者中(n = 52),开始使用 PPLAI 之前,每年平均入院次数为 0.53 次(标准差 0.49 次),之后为 0.01 次(标准差 0.06 次)(p < 0.001)。在实施 PPLAI 之前,每年的平均住院日为 31.3 天(标准差为 48.8 天),实施 PPLAI 之后为 12.4 天(标准差为 23.6 天)(p < 0.001)。在 PPLAI 启动后记录的住院日中,大部分都是在入院时记录的。只有两名患者在开始使用 PPLAI 后登记了住院日(不包括初始入院住院日)。这两名患者都是作为住院患者开始 PPLAI 的。图 1在图形浏览器中打开PowerPoint(A) 继续 PP3M 的患者在 PPLAI 启动前 3 年和启动后 3 年的每年平均住院日数,以及标准误差。(B) PPLAI 启用前 3 年和启用后 3 年,继续使用 PP3M 的患者每年的平均住院日数(含标准误差)。在观察期间,71 名开始使用 PP1M/3 M 的患者中只有 8 人(9.9%)入院治疗。我们的大多数患者(80%)在开始使用 PP1M 之前的 3 年中至少入院治疗过一次。持续 3 年的患者每年入院的平均次数减少了 98%。在观察期的最后 18 个月中,继续服用 PP3M 的患者没有入院治疗。在开始使用 PPLAIs 后,每年的平均住院天数减少了一半以上,但在开始使用 PP1M 后记录的住院天数中,有很大一部分是由于首次或指数入院造成的。在整个观察期内一直接受治疗的患者的住院日稳步下降,在治疗的第三年达到零住院日(平均住院日从第一年的 39.8 天降至第二年的 0.63 天,第三年降至 0.0 天)(图 1)。继续治疗者在第三年没有住院天数的情况表明,确保提供有效的抗精神病治疗可以有效地将精神病复发的风险降至零。这相当于每年节约成本 6521 英镑。最大剂量 PP3M(525 毫克)的年费用为 4711 英镑。3 然而,我们队列中的大多数人都服用了 350 毫克 PP3M。按此剂量计算,每年可节省净额 2752 英镑。同样重要的是要强调减少用药次数带来的额外益处,如减少工作人员用于注射程序的时间、增加患者在社区的活动和参与、改善社会关系以及减少因精神分裂症诊断而产生的耻辱感。
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来源期刊
Acta Psychiatrica Scandinavica
Acta Psychiatrica Scandinavica 医学-精神病学
CiteScore
11.20
自引率
3.00%
发文量
135
审稿时长
6-12 weeks
期刊介绍: Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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