Increased Adherence With Paliperidone Once Every 3 Months in Schizophrenia

injection, syringe, vaccine
injection, syringe, vaccine
Transition from a once-monthly formulation of a long-acting, injectable paliperidone palmitate to a once-every-3-month formulation treatment regimen in patients with schizophrenia demonstrated increased adherence to antipsychotic medication.

The following article is part of conference coverage from US Psych Congress 2018 in Orlando, Florida. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry. Check back for the latest news from US Psych Congress 2018.

ORLANDO, FL — Transition from a once-monthly formulation of a long-acting injectable paliperidone palmitate to a once-every-3-month formulation treatment regimen for commercially insured patients with schizophrenia demonstrated increased adherence to medication regimen and decreased prevalence of certain comorbidities, according to study results presented at the US Psych Congress 2018, held October 25 to 28 in Orlando, Florida.

Approximately 67% of patients with schizophrenia are non-adherent to their antipsychotic medication regimens. The development of long-acting injectable formulations of these medications has aided in the reduction of this non-adherence, and studies have shown that transitioning from a once-monthly regimen of long-acting injectable medications to once-every-3 months regimen has further aided in increased adherence to medication regimens, as well as decreased healthcare costs.

In a retrospective observational study, researchers gathered data from a health insurance claims database of >150 million enrollees from May 2014 to February 2018. The researchers included insured individuals age ­>18 who were diagnosed with schizophrenia within a 2-year period prior to study initiation and who had no longer than a 45-day gap in treatment with once-monthly injectable paliperidone over a 4-month period before transition to once-every-3 months treatment. The study measured comorbidities with the Elixhauser algorithm and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as well as antipsychotic medication adherence and month all-cause healthcare cost.

Of 152 participants who met all inclusion criteria and received treatment with once-every-3 months paliperidone, 64.5% were insured with Medicaid, with the next most common insurer being Medicare (20.4%). The measure of antipsychotic medication adherence was >80% in participants who transitioned from once-monthly long-acting injectable paliperidone to a once-every-3-months regimen, increasing from 65.1% to 78.9% (odds ratio [OR] 2.01; 95% CI, 1.21-3.33; P =.0007).

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This transition was also associated with a decrease from 84.9% to 76.3% in patients with comorbid psychoses (OR, .57; 95% CI, .35-.94; P =.0280). A similar decreased comorbidity was demonstrated in patients transitioning to once-every-3-month paliperidone with uncomplicated diabetes (23.0% to 17.8% decrease; OR, .72; 95% CI, .54-.97; P =.031), drug abuse (16.4% to 11.2% decrease; OR, .64; 95% CI, .41-.99; P =.044) and substance-related/addictive disorders (33.6% to 22.4% decrease; OR, .57; 95% CI, .41-.79).

Researchers found that there were no significant differences in healthcare costs in patients before vs after transition to once-every-3-months paliperidone: mean all-cause pharmacy and medical monthly cost difference = $242; 95% CI, −43 to 630; P =.120.

The study investigators concluded that improvement in adherence to antipsychotics with longer-acting injectable paliperidone palmitate was increased with no subsequent increase in healthcare costs and would thus enhance the overall health status of many patients with schizophrenia. 


Emond B, El Khoury AC, Patel C, et al. Real-world outcomes post-transition to once-every-3-months paliperidone palitate in patients with schizophrenia within US commercial plans. Presented at: US Psych Congress 2018; October 25-28, 2018; Orlando, Florida. Poster 213.