title: Concurrent Oral Antipsychotic Drug Use Among Schizophrenia Patients Initiated on Long-Acting Injectable Antipsychotics Post-Hospital Discharge.
abstract: Pharmacological treatment is central to effective management of schizophrenia. Prescribing clinicians have an increasing array of options from which to choose, and oral antipsychotic polypharmacy is common in routine clinical practice. Practice guidelines recommend long-acting injectable (LAI) formulations, typically viewed as monotherapeutic alternatives, for patients with established nonadherence. Yet there are limited data on the prevalence and nature of concurrent oral antipsychotic prescriptions in patients receiving LAIs. Our observational, claims-based study examined the frequency and duration of concurrent oral prescriptions in 340 Medicaid patients receiving LAI therapy. Specifically, we examined patients with a recent history of nonadherence and hospitalization for schizophrenia and included both first-generation antipsychotic depot medications (fluphenazine decanoate, haloperidol decanoate) and more recently available second-generation injectables (LAI risperidone, paliperidone palmitate). Of all patients initiated on LAIs, 75.9% had a concurrent oral antipsychotic prescription in the 6 months post-hospital discharge. Patients receiving concurrent prescriptions were frequently prescribed an oral formulation of their LAI agent, but many first-generation LAI users received a concurrent second-generation oral medication. The lowest rate of concurrent prescribing (58.8%) was found with paliperidone palmitate, whereas the highest rate was with LAI risperidone (88.9%). Overlap in oral and LAI prescriptions typically occurred for a substantial period of time (ie, >30 days) and for a notable percentage of the days covered by LAIs (often 50% or more). Our findings highlight the need to further examine such prescribing patterns, to probe the reasons for them, and to clarify the optimal roles of different antipsychotic treatments in clinical practice.
authors.affiliation: From the *Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; †Independent Consultant, Boston, MA; ‡Alkermes, Inc, Waltham, MA; and §University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA.
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.forename: Amy R
authors.initials: AR
authors.lastname: Pettit
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Stoddard
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Zummo
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D000284:Administration, Oral; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations