Treatment of Schizophrenia With Long-Acting Fluphenazine, Haloperidol, or Risperidone
Mark Olfson; Steven C. Marcus; Haya Ascher-Svanum
Abstract
Objective: This study compares 3 cohorts of patients with schizophrenia before, during, and after initiating treatment with fluphenazine decanoate (FD), haloperidol decanoate (HD), or long-acting injectable risperidone (LAR).
Methods: Administrative data are analyzed from California Medicaid (Medi-Cal) beneficiaries with schizophrenia who initiated FD, HD, or LAR treatment. Patients were required to have been continuously enrolled in Medi-Cal for 180 days before and 180 days after the start of the new episode of long-acting antipsychotic therapy.
Objective: This study compares 3 cohorts of patients with schizophrenia before, during, and after initiating treatment with fluphenazine decanoate (FD), haloperidol decanoate (HD), or long-acting injectable risperidone (LAR).
Methods: Administrative data are analyzed from California Medicaid (Medi-Cal) beneficiaries with schizophrenia who initiated FD, HD, or LAR treatment. Patients were required to have been continuously enrolled in Medi-Cal for 180 days before and 180 days after the start of the new episode of long-acting antipsychotic therapy.
Results: There were few demographic and clinical differences among patients initiating FD, HD, and LAR. During the 180 days before starting long-acting injections, most patients initiating FD 53.5%, HD 58.5%, and LAR 61.2% received oral antipsychotic medications for less 80% of the days in this period (medication possession ratio: small than 0.80). The mean duration of depot treatment episodes was 58.3 days. Few patients who started on FD 5.4%, HD 9.7%, or LAR 2.6% continued for at least 180 days. Most patients in each group FD 77.4%, HD 78.9%, and LAR 75.5% received oral antipsychotic medications during the 45 days after discontinuing long-acting injections. Coprescription with antidepressants, mood stabilizers, and benzodiazepines was common.
Conclusions: Patients treated with long-acting antipsychotic injections tend to have complex pharmacological regimens and recent medication nonadherence. A great majority of patients initiating long-acting antipsychotic medications discontinue use within the first few months of treatment.
Introduction
Long-acting antipsychotic medication injections are thought to help improve medication adherence in schizophrenia.Theoretical advantages of long-acting antipsychotic injections over oral medications include guaranteed delivery of medication, reliable monitoring of treatment adherence, and an increased opportunity for the treatment team to intervene as soon as a patient misses a dose. Clinical research and expert opinion support use of long-acting injection antipsychotic medications as maintenance treatment for patients with a history of medication nonadherence.
Approximately 15% of schizophrenia patients in maintenance antipsychotic treatment receive depot preparations. In one recent study, 29.9% of patients with schizophrenia and a recent history of antipsychotic nonadherence were currently being prescribed a long-acting injection antipsychotic medication. In the United States, psychiatrists tend to select long-acting injection medications for patients who have persistent psychotic symptoms and who frequently receive more than one concurrent antipsychotic medication. Use of depot antipsychotic medications may be increased among African Americans and patients with substance use problems.
Three antipsychotic medications are currently available in the United States as long-acting injections: fluphenazine decanoate (FD) or enanthate, haloperidol decanoate (HD), and long-acting injectable risperidone (LAR). These medications differ from one another in their pharmacokinetic and side-effect profiles. Little is known about the characteristics and service use patterns of patients who are treated with these medications in community practice.
In the current report, we use a large administrative database to compare and contrast the characteristics of schizophrenia patients starting FD, HD, and LAR and assess the continuity of their antipsychotic treatment. We also describe the use of oral antipsychotic and other psychotropic medications, treatment for selected comorbid conditions, and service use before, during, and after treatment with long-acting antipsychotic medications.
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Conclusions: Patients treated with long-acting antipsychotic injections tend to have complex pharmacological regimens and recent medication nonadherence. A great majority of patients initiating long-acting antipsychotic medications discontinue use within the first few months of treatment.
Introduction
Long-acting antipsychotic medication injections are thought to help improve medication adherence in schizophrenia.Theoretical advantages of long-acting antipsychotic injections over oral medications include guaranteed delivery of medication, reliable monitoring of treatment adherence, and an increased opportunity for the treatment team to intervene as soon as a patient misses a dose. Clinical research and expert opinion support use of long-acting injection antipsychotic medications as maintenance treatment for patients with a history of medication nonadherence.
Approximately 15% of schizophrenia patients in maintenance antipsychotic treatment receive depot preparations. In one recent study, 29.9% of patients with schizophrenia and a recent history of antipsychotic nonadherence were currently being prescribed a long-acting injection antipsychotic medication. In the United States, psychiatrists tend to select long-acting injection medications for patients who have persistent psychotic symptoms and who frequently receive more than one concurrent antipsychotic medication. Use of depot antipsychotic medications may be increased among African Americans and patients with substance use problems.
Three antipsychotic medications are currently available in the United States as long-acting injections: fluphenazine decanoate (FD) or enanthate, haloperidol decanoate (HD), and long-acting injectable risperidone (LAR). These medications differ from one another in their pharmacokinetic and side-effect profiles. Little is known about the characteristics and service use patterns of patients who are treated with these medications in community practice.
In the current report, we use a large administrative database to compare and contrast the characteristics of schizophrenia patients starting FD, HD, and LAR and assess the continuity of their antipsychotic treatment. We also describe the use of oral antipsychotic and other psychotropic medications, treatment for selected comorbid conditions, and service use before, during, and after treatment with long-acting antipsychotic medications.
DOWNLOAD COMPLETE PDF HERE
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