University of South Florida, Department of Mental Health Law & Policy, Tampa, FL 33612-3899, USA.
J Clin Psychiatry. 2011 Aug;72(8):1079-85. doi: 10.4088/JCP.09m05348yel. Epub 2010 Oct 19.
Medicaid claims were examined to determine whether utilization of risperidone long-acting therapy (LAT) was consistent with manufacturer's prescribing information recommendations and what factors were associated with early discontinuation.
Florida Medicaid claims between July 1, 2003, and June 30, 2007, were used. Recipient demographics and diagnoses, provision of oral antipsychotic supplementation during the first 21 days, number of injections received, medication possession ratio, and augmentation/polypharmacy after the first 21 days were assessed. Logistic regression was used to identify factors associated with early discontinuation of risperidone LAT.
There were 3,364 individuals who received 4,546 episodes of risperidone LAT. Most recipients were between 18 and 64 years and had schizophrenia or schizoaffective disorder. Median episode length was 106 days. Median number of injections was 5. Supplementation with oral antipsychotic during the first 21 days was provided in 48% of episodes. Mean dosages were 25 mg or less for 28% of episodes and greater than 75 mg for 7% of episodes. Augmentation/polypharmacy after the first 21 days occurred in 43% of episodes. Early risperidone LAT discontinuation was associated with absence of oral supplementation during the first 21 days (P < .001), low (P = .045) or high (P < .001) initial doses of risperidone LAT, prior inpatient treatment (P < .001), having a substance use disorder (P = .001), and being male (P = .036).
Prescribing practices for risperidone LAT were compared with the recommended protocol. Risperidone LAT was typically used with recommended age and diagnostic groups. However, important discrepancies were identified that could have reduced perceived effectiveness and tolerability of risperidone LAT. Early discontinuation was less likely when the recommendations in the manufacturer's prescribing information regarding dosage and supplementation with oral antipsychotics were followed.
通过审查医疗补助计划（Medicaid）的索赔记录，确定利培酮长效治疗（LAT）的使用是否符合制造商的处方信息建议，以及哪些因素与早期停药有关。
使用了 2003 年 7 月 1 日至 2007 年 6 月 30 日期间佛罗里达州医疗补助计划的索赔记录。评估了受种者的人口统计学和诊断信息、在最初 21 天内提供的口服抗精神病药物补充治疗、接受的注射次数、药物持有率以及在最初 21 天之后的增效/联合用药情况。采用逻辑回归来确定与利培酮 LAT 早期停药相关的因素。
有 3364 人接受了 4546 次利培酮 LAT 治疗。大多数受种者年龄在 18 至 64 岁之间，患有精神分裂症或分裂情感障碍。平均疗程为 106 天。平均注射次数为 5 次。在最初 21 天内，48%的疗程中提供了口服抗精神病药物的补充治疗。28%的疗程初始利培酮剂量为 25 毫克或以下，7%的疗程初始利培酮剂量大于 75 毫克。在最初 21 天之后，43%的疗程中进行了增效/联合用药。利培酮 LAT 的早期停药与最初 21 天内缺乏口服补充治疗（P <.001）、低（P =.045）或高（P <.001）初始利培酮 LAT 剂量、既往住院治疗（P <.001）、物质使用障碍（P =.001）和男性（P =.036）有关。
将利培酮 LAT 的处方实践与推荐方案进行了比较。利培酮 LAT 通常用于推荐的年龄和诊断组。然而，确定了一些重要的差异，这可能降低了利培酮 LAT 的有效性和耐受性。当遵循制造商的处方信息中关于剂量和口服抗精神病药物补充治疗的建议时，早期停药的可能性较低。
