Baseline characteristics and initial treatment decisions for patients with schizophrenia at risk of treatment nonadherence

Katarina Kelin¹, Alan JM Brnabic², Richard Newton³, Raúl I Escamilla⁴, Liang-Jen Chuo⁵, Malina Simu⁶, Wenyu Ye², William Montgomery¹, Jamie Karagianis⁷, Haya Ascher-Svanum^8
1Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia; ²Intercontinental Information Sciences, Eli Lilly Australia Pty Ltd, Macquarie Park, NSW, Australia; ³Peninsula Health Psychiatric Services, Frankston Hospital, Frankston, VIC, Australia (current affiliation: Department of Psychiatry, Austin Hospital, Heidelberg, VIC, Australia); ⁴Schizophrenia Clinic, National Institute of Psychiatry, Mexico City, México D.F; ⁵Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; ⁶St Stelian Hospital, Bucharest, Romania; ⁷Eli Lilly Canada Inc., Toronto, ON, Canada; ⁸US Outcomes Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA

Abstract: In this year-long, prospective observational study, sociodemographic, clinical, and functional characteristics were assessed in outpatients with schizophrenia from Australia, ­Mexico, Romania, and Taiwan who were switched from their primary oral antipsychotic to another oral or depot antipsychotic at study entry because of physician-perceived ­nonadherence risks. Patients (N = 406) rated their quality of life and functioning level as low. Few patients (10.6%, 43/406) were switched to depot antipsychotics, with country-specific differences (P < 0.001). Although illness severity was similar between subgroups, the depot switch ­subgroup had: a documented history of nonadherence (32.6% versus oral: 4.7%); recent alcohol (48.8% versus 23.2%; P < 0.001) or illicit drug use (16.3% versus 5.0%; P = 0.010); recent depot antipsychotic (20.7% versus 7.5%; P = 0.030) and mood stabilizer use (51.7% versus 26.3%; P = 0.008); poorer attitudes towards medication (P = 0.004); and poorer illness ­awareness (P = 0.041). Findings indicate that even when a risk of nonadherence has been identified, few patients with schizophrenia receive depot antipsychotics, despite being prime candidates for depot therapy. Findings suggest physicians may select depot therapy based on previous ­nonadherence, substance use, recent depot antipsychotic and mood stabilizer use, poor attitudes towards medications, and poor illness awareness.

Keywords: antipsychotic drugs, schizophrenia, depot antipsychotic, nonadherence