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Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement
Author(s) -
Alphs Larry,
Bossie Cynthia,
Mao Lian,
Lee Erin,
Starr H. Lynn
Publication year - 2018
Publication title -
early intervention in psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.087
H-Index - 45
eISSN - 1751-7893
pISSN - 1751-7885
DOI - 10.1111/eip.12271
Subject(s) - hazard ratio , medicine , schizophrenia (object oriented programming) , akathisia , adverse effect , psychiatry , paliperidone , proportional hazards model , antipsychotic , confidence interval
Aim Long‐acting injectable antipsychotics ( APs ) are not well studied in recent‐onset schizophrenia. This exploratory analysis of a study designed to reflect real‐world schizophrenia, as defined by patients, interventions and outcomes, compared relative treatment effect between once‐monthly paliperidone palmitate ( PP ) and daily oral APs in patients with recent‐onset or chronic illness Methods This randomized, open‐label, event monitoring board–blinded study compared treatment response in subjects with schizophrenia and a history of criminal justice system involvement following treatment with PP or oral APs for 15 months ( ClinicalTrials.gov identifier, NCT 01157351). Event‐free probabilities were estimated using K aplan– M eier method; hazard ratios ( HRs ) were estimated using Cox proportional hazard models. This subgroup analysis analysed data by disease duration (≤5 (recent‐onset) or >5 years (chronic illness) since first psychiatric diagnosis). Results Seventy‐seven subjects met the criteria for recent‐onset illness; 365 for chronic illness. HRs (95% CI ) for treatment failure for oral APs versus PP were 1.73 (0.87–3.45; P = 0.121) for recent‐onset and 1.37 (1.02–1.85; P = 0.039) for chronic illness. Most common adverse events for PP versus oral APs were injection site pain (recent‐onset, 26% vs. 0%; chronic, 17% vs. 0%), increased weight (14% vs. 6%; 12% vs. 6%), akathisia (14% vs. 9%; 10% vs. 7%), insomnia (12% vs. 17%; 18% vs. 10%) and anxiety (12% vs. 6%; 10% vs. 8%). Conclusions Although neither pre‐planned nor adequately powered, the estimated HRs suggest that the relative advantage of PP over oral APs for reducing the risk for treatment failure may be greater in patients with recent‐onset schizophrenia than in those with more chronic illness.