FACTORS ASSOCIATED WITH CONTINUATION OF PALIPERIDONE PALMITATE 1-MONTH FORMULATION MONOTHERAPY IN PATIENTS WITH SCHIZOPHRENIA
Authors: Marumoto *Tatsuro , Horio Hiroshi , Kinoshita Hiroaki , Morita Natsuko , Touma Tokiko , Takebe Kyoko , Wakamatsu Akihide 
Published: February 2025

Abstract

Background
Schizophrenia often requires long-term treatment with antipsychotics. Paliperidone palmitate long-acting injection (PPLAI) is one of the advantageous options to maintain adherence, prevent relapse and hospitalization (Kishimoto et al., 2021; Tiihonen et al., 2017). In Japan, paliperidone palmitate 1-monthly (PP1M) and paliperidone palmitate 3-monthly (PP3M) have been approved, and the approved patient population for PP3M in Japan is limited to patients with schizophrenia who have been stabilized with PP1M monotherapy. Antipsychotic polypharmacy consisting of LAI and oral antipsychotics (OAPs) are widely used in the clinical practice in many countries (Doshi et al., 2015; Aggarwal et al., 2012; Dimitropoulos et al., 2017; Cordiner et al., 2016; Joo et al., 2019), including Japan (Onitsuka et al., 2023). Hence, LAI monotherapy may be a more appropriate option in the long term. However, to date, factors associated with continuation for LAI monotherapy have not been examined. Therefore, we conducted a post-hoc analysis of a post-marketing surveillance (PMS) to explore factors associated with subsequent treatment continuation in patients who introduced PP1M monotherapy.

Aims & Objectives
The purpose of the post-hoc analysis is to identify factors associated with subsequent treatment continuation in schizophrenia patients in whom PP1M was introduced as a monotherapy.

Method
This study is a post-hoc analysis of the PMS in PP1M in Japan. The case enrollment period was from January 2014 to July 2015, and patients with schizophrenia who received PP1M according to the dosage and administration in the package insert were enrolled. The primary analysis population will be 698 of the 1306 patients enrolled in the PMS who were being treated with PP1M monotherapy treatment at the start of PP1M. Main endpoint will include time to drop out of monotherapy (all causes of dropping PP1M monotherapy). Factors associated with continuation of PP1M monotherapy will be assessed by using cox regression model. In this presentation, we will report on factors associated with subsequent treatment continuation in schizophrenia patients where PP1M was introduced as monotherapy.

References
Kishimoto, T., Hagi, K., Kurokawa, S., Kane, J. M., &Correll, C. U. (2021). Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. The lancet. Psychiatry, 8(5), 387–404. https://doi.org/10.1016/S2215-0366(21)00039-0
Tiihonen, J., Mittendorfer-Rutz, E., Majak, M., Mehtä lä, J., Hoti, F., Jedenius, E., Enkusson, D., Leval, A., Sermon, J., Tanskanen, A., &Taipale, H. (2017). Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29823 Patients With Schizophrenia. JAMA psychiatry, 74(7), 686–693. https://doi.org/10.1001/jamapsychiatry.2017.1322
Doshi, J. A., Pettit, A. R., Stoddard, J. J., Zummo, J., &Marcus, S. C. (2015). Concurrent Oral Antipsychotic Drug Use Among Schizophrenia Patients Initiated on Long-Acting Injectable Antipsychotics Post-Hospital Discharge. Journal of clinical psychopharmacology, 35(4), 442–446. https://doi.org/10.1097/JCP.0000000000000353
Aggarwal, N. K., Sernyak, M. J., &Rosenheck, R. A. (2012). Prevalence of concomitant oral antipsychotic drug use among patients treated with long-acting, intramuscular, antipsychotic medications. Journal of clinical psychopharmacology, 32(3), 323–328. https://doi.org/10.1097/JCP.0b013e31825244f6
Dimitropoulos, E., Drogemuller, L., &Wong, K. (2017). Evaluation of Concurrent Oral and Long-Acting Injectable Antipsychotic Prescribing at the Minneapolis Veterans Affairs Health Care System. Journal of clinical psychopharmacology, 37(5), 605–608. https://doi.org/10.1097/JCP.0000000000000755
Cordiner, M., Shajahan, P., McAvoy, S., Bashir, M., &Taylor, M. (2016). Effectiveness of long-acting antipsychotics in clinical practice: 2. Effects of antipsychotic polypharmacy on risperidone long-acting injection and zuclopenthixol decanoate. Therapeutic advances in psychopharmacology, 6(2), 66–76. https://doi.org/10.1177/2045125315623584
Joo, S. W., Shon, S. H., Choi, G., Koh, M., Cho, S. W., &Lee, J. (2019). Continuation of schizophrenia treatment with three long-acting injectable antipsychotics in South Korea: A nationwide population- based study. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(9), 1051–1060. https://doi.org/10.1016/j.euroneuro.2019.07.138
Onitsuka, T., Okada, T., Hasegawa, N., Tsuboi, T., Iga, J. I., Yasui-Furukori, N., Yamada, N., Hori, H., Muraoka, H., Ohi, K., Ogasawara, K., Shinichiro, O., Takeshima, M., Ichihashi, K., Fukumoto, K., Iida, H., Yamada, H., Furihata, R., Makinodan, M., Takaesu, Y., … Hashimoto, R. (2023). Combination Psychotropic Use for Schizophrenia With Long-Acting Injectable Antipsychotics and Oral Antipsychotics: A Nationwide Real-World Study in Japan. Journal of clinical psychopharmacology, 10.1097/JCP.0000000000001704. Advance online publication. https://doi.org/10.1097/JCP.0000000000001704