Pilon Dominic, Amos Tony B, Germain Guillaume, Lafeuille Marie-Hélène, Lefebvre Patrick, Benson Carmela J
a Groupe d'analyse Ltée , Montréal , QC , Canada.
b Janssen Scientific Affairs LLC , Titusville , NJ , USA.
Curr Med Res Opin. 2017 Apr;33(4):713-721. doi: 10.1080/03007995.2016.1277989. Epub 2017 Feb 13.
The effective treatment of schizophrenia requires continuous antipsychotic maintenance therapy. However, poor persistence with treatment is common among patients with schizophrenia. The objective of this study was to compare persistence and hospitalization rates among patients with schizophrenia treated with long-acting injectable (LAI) antipsychotics (i.e. paliperidone palmitate and risperidone) and enrolled in a patient information program (program cohort) with patients treated with oral antipsychotics (OAs) who were not enrolled in a patient information program (nonprogram cohort).
Using a quasi-experimental design, data from chart reviews (for program patients) and Medicaid claims (for nonprogram patients) was analyzed. Patients were eligible if they had ≥12 months of pre-index data, ≥6 months of post-index data, and no hospitalization at index.
Persistence and hospitalization rates were assessed at 6 months post-index. Propensity score matching was used to control for observed differences in demographics and baseline clinical characteristics. Odds ratios (ORs) were calculated using generalized estimating equation models and adjusted for matched pairs and propensity score.
A total of 102 program patients were matched to 408 nonprogram patients with similar baseline characteristics. Adjusted ORs indicated that the persistence rate at 6 months was significantly higher for the program cohort (88.2%) versus the nonprogram cohort (43.9%; OR: 9.70; P < .0001). The 6 month post-index hospitalization rate for the program cohort (14.7%) was significantly lower versus the nonprogram cohort after adjustments (22.5%; OR: 0.55; P = 0.0321).
The data for the program and nonprogram patients were from two different and independent data sources (healthcare claims and chart reviews, respectively). Results were based on a relatively small number of program LAI patients.
Program patients treated with LAI antipsychotics had higher persistence rates and significantly lower adjusted hospitalization rates compared with nonprogram patients treated with OAs.
精神分裂症的有效治疗需要持续的抗精神病药物维持治疗。然而，精神分裂症患者中治疗依从性差的情况很常见。本研究的目的是比较接受长效注射用（LAI）抗精神病药物（即棕榈酸帕利哌酮和利培酮）治疗并参加患者信息项目的精神分裂症患者（项目队列）与接受口服抗精神病药物（OAs）治疗但未参加患者信息项目的患者（非项目队列）的治疗依从性和住院率。
采用准实验设计，分析了病历回顾（针对项目患者）和医疗补助索赔（针对非项目患者）的数据。如果患者有≥12个月的索引前数据、≥6个月的索引后数据且索引时未住院，则符合入选条件。
在索引后6个月评估治疗依从性和住院率。倾向评分匹配用于控制人口统计学和基线临床特征方面观察到的差异。使用广义估计方程模型计算比值比（ORs），并针对匹配对和倾向评分进行调整。
共有102名项目患者与408名具有相似基线特征的非项目患者进行了匹配。调整后的ORs表明，项目队列在6个月时的治疗依从率（88.2%）显著高于非项目队列（43.9%；OR：9.70；P <.0001）。调整后，项目队列索引后6个月的住院率（14.7%）显著低于非项目队列（22.5%；OR：0.55；P = 0.0321）。
项目患者和非项目患者的数据分别来自两个不同且独立的数据源（医疗保健索赔和病历回顾）。结果基于相对较少数量的项目LAI患者。
与接受OAs治疗的非项目患者相比，接受LAI抗精神病药物治疗的项目患者具有更高的治疗依从率和显著更低的调整后住院率。
