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Abstract
Background: paliperidone palmitate is one of the most widely-prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.
Methods: EHR data were obtained from 1,281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with an LAI antipsychotic between 1st April 2011 and 31st January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.
Results: Patients treated with paliperidone palmitate (n=430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% CI -57.3 to 68.2, p=0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p=0.82).
Conclusion: paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.
Methods: EHR data were obtained from 1,281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with an LAI antipsychotic between 1st April 2011 and 31st January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.
Results: Patients treated with paliperidone palmitate (n=430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% CI -57.3 to 68.2, p=0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p=0.82).
Conclusion: paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.
| Original language | English |
|---|---|
| Pages (from-to) | 1616-1623 |
| Journal | Psychological Medicine |
| Volume | 48 |
| Issue number | 10 |
| Early online date | 17 Oct 2017 |
| DOIs | |
| Publication status | Published - Jul 2018 |
Keywords
- LAI
- paliperidone
- xeplion
- trevicta
- schizophrenia
- psychosis
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- 1 Finished
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Predicting clinical and functional outcomes in psychosis using machine learning.
Patel, R., Dazzan, P., McGuire, P., Mechelli, A. & Stewart, R.
14/01/2013 → 13/01/2016
Project: Research