Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Adv Ther. 2019 Apr;36(4):858-869. doi: 10.1007/s12325-019-00913-w. Epub 2019 Mar 8.
Factors underlying the selection of antipsychotics for patients with schizophrenia are poorly understood. This study investigated variables associated with initiation of treatment with the long-acting injectables paliperidone palmitate (LAI-PP) and aripiprazole LAI (LAI-AP) in Medicaid patients with schizophrenia.
Adults with at least one medical or pharmacy claim for LAI-PP or LAI-AP from 1 January 2013 to 31 December 2016 were selected from the IBM MarketScan Medicaid Database. The date of the first LAI-PP or LAI-AP claim was the index date. Patients who had at least two medical claims, on different days, for a schizophrenia diagnosis and at least 12 months of continuous health plan enrollment prior to index date were included in the analysis. Multivariable logistic regression was performed to determine the factors associated with the initiation of LAI-PP versus LAI-AP.
Of included patients, 5501 initiated LAI-PP and 1449 initiated LAI-AP. Patients more likely to initiate LAI-PP versus LAI-AP were older, male, or African American (all p < 0.01). Patients with obesity (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.71, 0.98), post-traumatic stress disorder (OR 0.76; 95% CI 0.63, 0.92), or prior oral antipsychotic use (OR 0.66; 95% CI 0.55, 0.79) were less likely to initiate LAI-PP; whereas, patients with nonorganic psychoses (OR 1.35; 95% CI 1.18, 1.55) or prior use of other injectable antipsychotics (OR 1.26; 95% CI 1.09, 1.47) were more likely to initiate LAI-PP versus LAI-AP. Patients with at least two all-cause hospitalizations were 1.37 times more likely to initiate LAI-PP vs LAI-AP (OR 1.37; 95% CI 1.18, 1.60).
Factors associated with initiating LAI-PP and LAI-AP differed. Notably, patients who initiated LAI-PP had greater prior use of medical services than LAI-AP patients. Understanding prescribing practices may help optimize treatment strategies and improve disease management.
Janssen Scientific Affairs, LLC.
精神分裂症患者选择抗精神病药物的因素尚不清楚。本研究调查了 Medicaid 精神分裂症患者接受长效注射用棕榈酸帕利哌酮（LAI-PP）和阿立哌唑 LAI（LAI-AP）治疗的起始相关变量。
从 IBM MarketScan Medicaid 数据库中选择至少有一次 LAI-PP 或 LAI-AP 医疗或药房索赔的成年人。首次 LAI-PP 或 LAI-AP 索赔的日期为索引日期。在索引日期之前，至少有两次精神分裂症诊断的医疗索赔（不同日期），且至少有 12 个月的连续健康计划参保的患者纳入分析。进行多变量逻辑回归以确定与 LAI-PP 与 LAI-AP 起始相关的因素。
纳入的患者中，5501 例患者起始 LAI-PP，1449 例患者起始 LAI-AP。与 LAI-AP 相比，更有可能起始 LAI-PP 的患者年龄较大、男性或非裔美国人（均 P<0.01）。肥胖（比值比[OR]0.84；95%置信区间[CI]0.71，0.98）、创伤后应激障碍（OR 0.76；95%CI 0.63，0.92）或先前使用口服抗精神病药（OR 0.66；95%CI 0.55，0.79）的患者不太可能起始 LAI-PP；而非器质性精神病（OR 1.35；95%CI 1.18，1.55）或先前使用其他注射用抗精神病药（OR 1.26；95%CI 1.09，1.47）的患者更有可能起始 LAI-PP 而非 LAI-AP。至少有两次全因住院的患者起始 LAI-PP 的可能性是起始 LAI-AP 的 1.37 倍（OR 1.37；95%CI 1.18，1.60）。
起始 LAI-PP 和 LAI-AP 的相关因素不同。值得注意的是，起始 LAI-PP 的患者比起始 LAI-AP 的患者先前使用医疗服务的情况更多。了解处方实践可能有助于优化治疗策略并改善疾病管理。
Janssen 科学事务公司。
