Kang Nuree, Jo Ae Jeong, Joo Sung Woo, Lee Jung Sun, Lee Kyu Young, Kim Yong Sik, Jeong Jae Hoon, Lee Jeong Hoon, Lee Joongyub, Kim Se Hyun
Department of Psychiatry, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea.
Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
Ther Adv Psychopharmacol. 2025 Apr 22;15:20451253251333987. doi: 10.1177/20451253251333987. eCollection 2025.
Long-acting injectable (LAI) antipsychotics have been shown to improve adherence and clinical outcomes in schizophrenia treatment. However, issues with compliance and early discontinuation of LAIs remain a significant challenge in real-world settings. Understanding the factors influencing successful initiation and maintenance is essential to maximize their clinical benefits.
This study aimed to investigate factors associated with the maintenance of paliperidone LAI (PLAI) during the first year of treatment in a real-world clinical setting, focusing on initiation practices and baseline clinical factors.
This was a non-interventional, retrospective observational study conducted at three hospitals in South Korea. Data were collected from electronic medical records from January 2010 to January 2023.
This study included 664 patients who initiated PLAI treatment. Kaplan-Meier survival analysis and multivariate Cox proportional hazards models were used to evaluate clinical and demographic factors influencing the 1-year discontinuation rate.
The 1-year discontinuation rate was 51.5% (342/664), with most discontinuations occurring in the early phase of treatment. Factors significantly associated with a lower risk of discontinuation included initiating PLAI with the standard starting dose of 150 mg (hazards ratio (HR) 0.766, = 0.021), concurrent use of antipsychotics at baseline (HR 0.630, = 0.019), a higher dose of concurrent antipsychotics (HR 0.985, = 0.005), and outpatient initiation (HR 0.671, < 0.001). Baseline clozapine use was associated with a lower risk of treatment discontinuation (HR 0.755, = 0.096). A predictive model incorporating these factors demonstrated moderate ability to predict 1-year discontinuation (area under the curve (AUC) = 0.61).
The findings highlight the importance of adhering to the standard dosing regimen for PLAI initiation and its potential as an augmentation agent in combination with other antipsychotics. Initiating PLAI in an outpatient setting and addressing adherence challenges early in treatment may enhance long-term treatment continuity in patients with schizophrenia.
长效注射用（LAI）抗精神病药物已被证明可提高精神分裂症治疗的依从性和临床疗效。然而，在现实环境中，LAI的依从性问题和早期停药仍然是一个重大挑战。了解影响成功起始和维持治疗的因素对于最大化其临床益处至关重要。
本研究旨在调查在现实临床环境中治疗的第一年期间与帕利哌酮长效注射剂（PLAI）维持治疗相关的因素，重点关注起始治疗方法和基线临床因素。
这是一项在韩国三家医院进行的非干预性回顾性观察研究。数据收集自2010年1月至2023年1月的电子病历。
本研究纳入了664例起始PLAI治疗的患者。采用Kaplan-Meier生存分析和多变量Cox比例风险模型来评估影响1年停药率的临床和人口统计学因素。
1年停药率为51.5%（342/664），大多数停药发生在治疗早期。与较低停药风险显著相关的因素包括以150mg的标准起始剂量起始PLAI（风险比（HR）0.766，P = 0.021）、基线时同时使用抗精神病药物（HR 0.630，P = 0.019）、同时使用抗精神病药物的剂量较高（HR 0.985，P = 0.005）以及门诊起始治疗（HR 0.671，P < 0.001）。基线时使用氯氮平与较低的治疗停药风险相关（HR 0.755，P = 0.096）。纳入这些因素的预测模型显示出中等的预测1年停药的能力（曲线下面积（AUC）= 0.61）。
研究结果突出了坚持PLAI起始治疗的标准给药方案的重要性及其作为与其他抗精神病药物联合使用的增效剂的潜力。在门诊环境中起始PLAI治疗并在治疗早期解决依从性挑战可能会增强精神分裂症患者的长期治疗连续性。
