The Impact of Paliperidone Palmitate on Hospitalization in Patients with Schizophrenia: A Retrospective Mirror-image Study
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Objective: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral antipsychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. Methods: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. Results: The mean number of admissions fell from 0.83 to 0.17 per patient (p ＜ 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p ＜ 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. Conclusion: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.
Abstract
Objective: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral antipsychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. Methods: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. Results: The mean number of admissions fell from 0.83 to 0.17 per patient (p ＜ 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p ＜ 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. Conclusion: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.
참고문헌 (34)
- Ascher-Svanum H, "Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care", J Clin Psychiatry, 67, pp.453~460 (2006)
- Miyamoto S, "Treatments for schizophrenia : a critical review of pharmacology and mechanisms of action of antipsychotic drugs", Mol Psychiatry, 10, pp.79~104 (2005)
- Morken G, "Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia", BMC Psychiatry, 8, pp.32~ (2008)
- Novick D, "Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia", Psychiatry Res, 176, pp.109~113 (2010)
- Barkhof E, "Interventions to improve adherence to antipsychotic medication in patients with schizophrenia--a review of the past decade", Eur Psychiatry, 27, pp.9~18 (2012)
- Haddad PM, "Nonadherence with antipsychotic medication in schizophrenia : challenges and management strategies", Patient Relat Outcome Meas, 5, pp.43~62 (2014)
- Seon-Cheol Park, "Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis", Clinical Psychopharmacology and Neuroscience, 16(4), pp.361~375 (2018), 대한정신약물학회[DOI]
- Ulku Akyol Ardic, "Efficacy and Safety Profile of Risperidone Long-acting Injection in Adolescents in a Real-life Setting", Clinical Psychopharmacology and Neuroscience, 16(1), pp.57~61 (2018), 대한정신약물학회[DOI]
- Brissos S, "The role of long-acting injectable antipsychotics in schizophrenia : a critical appraisal", Ther Adv Psychopharmacol, 4, pp.198~219 (2014)
- Dolder C, "Paliperidone for schizophrenia", Am J Health Syst Pharm, 65, pp.403~413 (2008)
- Jarema M, "Paliperidone palmitate : effectiveness, safety, and the use for treatment of schizophrenia", Psychiatr Pol, 51, pp.7~21 (2017)
- Gopal S, "Efficacy and safety of paliperidone palmitate in adult patients with acutely symptomatic schizophrenia : a randomized, double-blind, placebo-controlled, dose-response study", Int Clin Psychopharmacol, 25, pp.247~256 (2010)
- Hough D, "Paliperidone palmitate maintenance treatment in delaying the time-to-relapse in patients with schizophrenia : a randomized, double-blind, placebo-controlled study", Schizophr Res, 116, pp.107~117 (2010)
- Kramer M, "Paliperidone palmitate, a potential long-acting treatment for patients with schizophrenia. Results of a randomized, double- blind, placebo-controlled efficacy and safety study", Int J Neuropsychopharmacol, 13, pp.635~647 (2010)
- Pandina GJ, "A randomized, placebo-controlled study to assess the efficacy and safety of 3 doses of paliperidone palmitate in adults with acutely exacerbated schizophrenia", J Clin Psychopharmacol, 30, pp.235~244 (2010)
- Kishimoto T, "Long-acting injectable versus oral antipsychotics in schizophrenia : a systematic review and meta-analysis of mirror-image studies", J Clin Psychiatry, 74, pp.957~965 (2013)
- Kishimoto T, "Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia : a meta-analysis of randomized trials", Schizophr Bull, 40, pp.192~213 (2014)
- Haddad PM, "Ambiguous findings concerning potential advantages of depot antipsychotics : in search of clinical relevance", Curr Opin Psychiatry, 28, pp.216~221 (2015)
- Kane JM, "Non-adherence to medication in patients with psychotic disorders : epidemiology, contributing factors and management strategies", World Psychiatry, 12, pp.216~226 (2013)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2013), American Psychiatric Association
- Guy W, "ECDEU assessment manual for psychopharmacology", US Department of Health, Education, and Welfare, 534~537 (1976)
- Woods SW, "Chlorpromazine equivalent doses for the newer atypical antipsychotics", J Clin Psychiatry, 64, pp.663~667 (2003)
- Gopal S, "Practical guidance for dosing and switching paliperidone palmitate treatment in patients with schizophrenia", Curr Med Res Opin, 26, pp.377~387 (2010)
- Taylor D, "Long-acting paliperidone palmitate-interim results of an observational study of its effect on hospitalization", Int Clin Psychopharmacol, 29, pp.229~234 (2014)
- Taylor DM, "Effect of paliperidone palmitate on hospitalisation in a naturalistic cohort-a four-year mirror image study", Eur Psychiatry, 37, pp.43~48 (2016)
- Bressington D, "A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates", Int Clin Psychopharmacol, 30, pp.230~236 (2015)
- Vincent PD, "One year mirror-image study using paliperidone palmitate for relapse prevention of schizophrenia in four university hospitals in Canada", Schizophr Res, 185, pp.96~100 (2017)
- Nikolić N, "The impact of paliperidone palmitate long-acting injection on hospital admissions in a mental health setting", Int Clin Psychopharmacol, 32, pp.95~102 (2017)
- Ayuso-Gutiérrez JL, "Factors influencing relapse in the long-term course of schizophrenia", Schizophr Res, 28, pp.199~206 (1997)
- Kay SR, "The positive and negative syndrome scale(PANSS)for schizophrenia", Schizophr Bull, 13, pp.261~276 (1987)
- Cutler A, "Dosing atypical antipsychotics", CNS Spectr, 13(5 Suppl 9), pp.1~16 (2008)
- 강현구, "조현병 환자에서 장기지속형 항정신병 주사제 팔리페리돈 팔미테이트의 효능과 안전 : 24주 개방형 연구", 생물정신의학, 20(3), pp.111~117 (2013), 대한생물정신의학회
- 김보라미, "한국의 비순응 조현병 환자에서 경구용 비정형 항정신병 약물 대비 항정신병 장기지속형 주사제 Paliperidone Palmitate의 비용-효용분석", 대한정신약물학회지, 23(1), pp.17~27 (2012), 대한정신약물학회
- 김하린, "팔리페리돈 장기지속형주사제의 약물 순응도와 치료 효과", 신경정신의학, 54(1), pp.69~75 (2015), 대한신경정신의학회[DOI]