Correll Christoph U, Benson Carmela, Emond Bruno, Patel Charmi, Lafeuille Marie-Hélène, Lin Dee, Morrison Laura, Ghelerter Isabelle, Lefebvre Patrick, Mavros Panagiotis
The Zucker Hillside Hospital, Northwell Health, New York, NY, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Schizophrenia (Heidelb). 2023 Feb 11;9(1):9. doi: 10.1038/s41537-023-00334-3.
This retrospective study evaluated the benefit of following different long-acting injectable (LAI) initiation strategies based on the timing of behavioral and clinical events among Medicaid beneficiaries with schizophrenia. Adults with schizophrenia initiating oral antipsychotics (OAPs) after 12 months without antipsychotic use or schizophrenia-related inpatient/emergency room (ER) visits (index date) were identified. Patients were categorized into four event-driven LAI initiation strategy cohorts based on observed sequences of behavioral (i.e., OAP adherence) and clinical (i.e., schizophrenia-related inpatient/ER visits) events between index and LAI initiation or censoring-strategy #1: adherent to OAPs without schizophrenia-related inpatient/ER visits; strategy #2: nonadherent to OAPs without schizophrenia-related inpatient/ER visits; strategy #3: one schizophrenia-related inpatient/ER visit; strategy #4: ≥2 schizophrenia-related inpatient/ER visits. Clinical outcomes (i.e., all-cause inpatient/ER visits) were evaluated between OAP initiation and end of follow-up. Comparisons between LAI initiation strategy cohorts were conducted using a dynamic marginal structural model adjusting for baseline characteristics and time-varying confounders. Among 13,444 eligible patients, 13.1%, 53.6%, 15.7%, and 17.6% were following strategies #1-4, respectively; of these, 21.9%, 4.3%, 9.2%, and 6.5% started an LAI (the remaining were censored). Strategy #1 was associated with a greater clinical benefit, with 43%, 69%, and 80% fewer inpatient days (all p < 0.05); and 57%, 59%, and 79% fewer ER visits (all p < 0.01) vs strategies #2-4, respectively; the clinical benefit was also observed for strategy #2 vs #3-4. Therefore, starting an LAI prior to OAP nonadherence or occurrence of a schizophrenia-related inpatient/ER visit was associated with fewer all-cause inpatient days of inpatient stay and ER visits.
这项回顾性研究评估了在患有精神分裂症的医疗补助受益人中，根据行为和临床事件发生时间遵循不同长效注射（LAI）起始策略的益处。确定了在未使用抗精神病药物或未因精神分裂症相关原因住院/急诊室（ER）就诊12个月后开始口服抗精神病药物（OAP）的成年精神分裂症患者（索引日期）。根据索引日期至LAI起始或审查期间观察到的行为（即OAP依从性）和临床（即精神分裂症相关住院/ER就诊）事件序列，将患者分为四个事件驱动的LAI起始策略队列：策略1：坚持服用OAP且无精神分裂症相关住院/ER就诊；策略2：不坚持服用OAP且无精神分裂症相关住院/ER就诊；策略3：有一次精神分裂症相关住院/ER就诊；策略4：有≥2次精神分裂症相关住院/ER就诊。在OAP起始至随访结束期间评估临床结局（即全因住院/ER就诊）。使用动态边际结构模型对LAI起始策略队列进行比较，该模型对基线特征和随时间变化的混杂因素进行了调整。在13444名符合条件的患者中，分别有13.1%、53.6%、15.7%和17.6%遵循策略1-4；其中，21.9%、4.3%、9.2%和6.5%开始使用LAI（其余被审查）。策略1与更大的临床益处相关，与策略2-4相比，住院天数分别减少43%、69%和80%（所有p<0.05）；急诊就诊次数分别减少57%、59%和79%（所有p<0.01）；与策略3-4相比，策略2也观察到了临床益处。因此，在不坚持服用OAP或出现精神分裂症相关住院/ER就诊之前开始使用LAI与全因住院天数和急诊就诊次数减少相关。
