Treatment adherence among patients with schizophrenia treated with atypical and typical antipsychotics

Case Western Reserve University, Cleveland, Ohio, United States
Psychiatry Research (Impact Factor: 2.68). 12/2006; 144(2-3):177-89. DOI: 10.1016/j.psychres.2006.02.006
Source: PubMed

ABSTRACT This study evaluated treatment adherence among patients with schizophrenia receiving atypical and typical antipsychotics. Claims data for 7017 treatment episodes of commercially insured patients with schizophrenia (ICD-9-CM) receiving antipsychotics, covering the period from January 1999 through August 2003, were assessed. Overall adherence was evaluated by adherence intensity (medication possession ratio) and treatment duration (length of treatment episode). Pair-wise comparisons of the individual atypicals and a combined group of leading typical antipsychotics were undertaken using multiple regression, adjusting for differing patient characteristics. Each atypical antipsychotic demonstrated a significantly higher adherence intensity than the combined typicals, while quetiapine demonstrated a significantly greater adherence intensity than risperidone and olanzapine. None of the atypicals showed treatment durations significantly different from the typicals. While the small improvements in adherence intensity among atypical agents do not appear to be clinically important, they may reflect an underlying, stronger tendency to use filled prescriptions.

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    • "Some previous studies have reported modestly-increased rates of adherence with atypical antipsychotic medication (i.e. Dolder et al. 2002; Gianfrancesco et al. 2006; Lang et al. 2010; Perkins 2002; Voruganti et al. 2000), while other studies have opposing findings (Valenstein et al. 2004). It is surprising to note that only 28% of participants in this study were prescribed atypical antipsychotics, which is very low in comparison to the 2006–2007 rates of 67% reported by NICE (2008) in the UK. "
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    ABSTRACT: The purpose of the present study was to examine the factors affecting adherence to antipsychotic medication in patients with schizophrenia registered with a community psychiatric nursing service in Hong Kong. The study was a cross-sectional observational survey; symptoms, drug attitudes, insight, side-effects, and sociodemographic characteristics were measured and explored in terms of their relationship with medication adherence. A total of 584 patients who were visited by community psychiatric nurses (CPN) participated, and 30% of these patients were non-adherent with their antipsychotic medication. Positive treatment attitudes, awareness of the need for treatment, being prescribed clozapine, receiving state benefits, lower levels of symptoms, and fewer side-effects were associated with adherence. The findings from this study suggest that the clinical efforts of CPN to improve adherence should aim to help patients amplify the personal relevance of treatment and modify patients' attitudes towards medication.
    International journal of mental health nursing 06/2012; 22(1). DOI:10.1111/j.1447-0349.2012.00830.x · 2.01 Impact Factor
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    • "Adherence to therapy is also an important challenge in the management of schizophrenia. The adverse effects of antipsychotic treatment, as well as restrictive dosing regimens (such as the requirement to take drugs with food or multiple times a day), are a few of several factors that may compromise oral antipsychotic treatment adherence (Cooper et al, 2007; Gianfrancesco et al, 2006; Keith and Kane, 2003). General dissatisfaction with oral antipsychotic therapy was underscored by results from the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study, which indicated that although 10–18% of patients discontinued initial treatment because of adverse events, Received 1 January 2010; revised 12 April 2010; accepted 4 May 2010 Previous presentations: Data from this study were presented at the American Psychiatric Association 161st Annual Meeting, 3–8 May 2008, and the 60th Institute of Psychiatric Services Annual Meeting, 2–5 October 2008. "
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    ABSTRACT: Paliperidone palmitate is a long-acting injectable antipsychotic agent. This 13-week, multicenter, randomized (1 : 1 : 1 : 1), double-blind, parallel-group study evaluated the efficacy, safety, and tolerability of fixed 25, 50, and 100 milligram equivalent (mg equiv.) doses of paliperidone palmitate vs placebo administered as gluteal injections on days 1 and 8, then every 4 weeks (days 36 and 64) in 518 adult patients with schizophrenia. The intent-to-treat analysis set (N=514) was 67% men and 67% White, with a mean age of 41 years. All paliperidone palmitate dose groups showed significant improvement vs placebo in the Positive and Negative Syndrome Scale (PANSS) total score (primary efficacy measure; 25 and 50 mg equiv., p=0.02; 100 mg equiv., p<0.001), as well as Clinical Global Impression Severity scores (p< or =0.006) and PANSS negative and positive symptom Marder factor scores (p< or =0.04). The Personal and Social Performance scale showed no significant difference between treatment groups. The overall incidence of treatment-emergent adverse events was similar between groups. Parkinsonism, the most frequently reported extrapyramidal symptom, was reported at similar rates for placebo (5%) and paliperidone palmitate (5-6% across doses). The mean body mass index and mean weight showed relatively small dose-related increases during paliperidone palmitate treatment. Investigator-evaluated injection-site pain, swelling, redness, and induration were similar across treatment groups; scores for patient-evaluated injection-site pain (visual analog scale) were similar across groups and diminished with time. All doses of once-monthly paliperidone palmitate were efficacious and generally tolerated, both locally and systemically. Paliperidone palmitate offers the potential to improve outcomes in adults with symptomatic schizophrenia.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 09/2010; 35(10):2072-82. DOI:10.1038/npp.2010.79 · 7.83 Impact Factor
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    • "These differences may be attributed to the changes in prescribing practice seen after the advent of atypical antipsychotics. A US study by Gianfrancesco et al (2006) examined data from the medical claim forms of over 7000 patients to try and establish whether treatment adherence was improved in people taking atypical antipsychotics in comparison to typical antipsychotics. The findings suggest that adherence intensity was slightly improved in the atypical group, but the duration of treatment between the two groups was not statistically significant. "
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