Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence
Katarina Kelin1, Timothy JR Lambert2, Alan JM Brnabic3, Richard Newton4, Wendy Ye3, Raúl I Escamilla5, Kuang-Peng Chen6, Liana Don7, William Montgomery1, Jamie Karagianis8, Haya Ascher-Svanum9
1Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia; 2Discipline of Psychiatry, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia; 3Intercontinental Information Sciences, Eli Lilly Australia Pty Ltd, Macquarie Park, NSW, Australia; 4Peninsula Health Psychiatric Services, Frankston Hospital, Frankston, VIC, Australia (current affiliation: Department of Psychiatry, Austin Hospital, Heidelberg, VIC, Australia); 5Schizophrenia Clinic, National Institute of Psychiatry, Mexico City, Mexico; 6Department of Psychiatry, National Taiwan University Hospital, Yun-Lin, Taiwan; 7Department of Psychiatry, University of Medicine Iuliu Hatieganu Cluj Napoca, Romania; 8Lilly USA, Eli Lilly and Company, Indianapolis, IN, USA; 9Global Health Outcomes, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
Background: This study aimed to improve physicians' understanding of the treatment circumstances and needs of outpatients with schizophrenia at risk of nonadherence, by naturalistically assessing antipsychotic treatment patterns, clinical outcomes, and health care service use in this little-studied patient population.
Methods: In this one-year, prospective, multicenter, noninterventional, observational study, patients considered at risk of nonadherence by their physicians were switched from their primary oral antipsychotic to another oral or a depot antipsychotic at study entry. All cause treatment discontinuation (antipsychotic switch, augmentation, or discontinuation) during the study was assessed using Kaplan–Meier survival analyses and descriptive statistics. Patients’ illness severity, quality of life, attitude towards medication, patient-reported adherence, and health care resource utilization were assessed during the study.
Results: Of the 406 enrolled patients, 43 (10.6%) were switched to depot and 363 (89.4%) were switched to oral antipsychotics at study entry. During the study, 99 (24.4%) patients switched, augmented, or discontinued their antipsychotic (all cause treatment discontinuation). Of the 99 patients who switched, augmented, or discontinued their antipsychotic, 8 (18.6%) were taking depot and 91 (25.0%) were taking oral antipsychotics. These patients were switched to either depot (n = 15) or oral (n = 78) antipsychotics, or discontinued their antipsychotic medication (n = 6). Inadequate response was the most frequently reported reason for medication discontinuation. During the study, patients’ clinical and functional status improved significantly and service use was low. Most patients considered themselves to be adherent at study entry, and this favorable self-perception increased during the study (from 68.5% to 88.1%).
Conclusion: Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study. The discrepancy between the physicians’ perception of their patient’s medication adherence and the patients’ self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.
Keywords: antipsychotic drugs, medication persistence, outpatients, schizophrenia, depot antipsychotic, nonadherence