USING SGAS L.A.I. IN YOUNG ADULT SCHIZOPHRENIC … · USING SGAS L.A.I. IN YOUNG ADULT...
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USING SGAS L.A.I. IN YOUNG ADULT SCHIZOPHRENIC PATIENTS AT PORDENONE MENTAL HEALTH DEPARTMENT G.Commodari (1) , B.Basso (2) , A.Cassin (1) Background Schizophrenia is a recurrent and chronic disease which requires a long term treatment. Antipsychotics (AP) can reduce relapse rates; non-adherence with such treatment is associated with both short- term and long-term negative consequences. Second Generation Antipsychotics (SGAs) represent the current standard of care for schizophrenia. SGAs are considered better tolerated than First Generation Antipsychotics (FGA), although non-adherence is not much different than conventional compounds. Long-acting injectable antipsychotics (L.A.I.) can prove useful for distinguishing poor adherence versus poor response, may alleviate problems of treatment adherence and allow a more constant plasma concentration thereby reducing the occurrence of relapse. Results The province of Pordenone has about 314.000 inhabitants and the D.S.M. is in charge of 884 patients with a diagnosis of schizophrenia. During the course of 8 years, 242 patients received a SGAs L.A.I. of which 41 were young-adults: 18 cases received Risperidone, 18 Paliperidone, 1 Aripiprazole, 4 cases Risperidone and Paliperidone (tab 2) Aim of the study Our analysis focused on the prescription methods of SGAs L.A.I. in young adult patients at Pordenone Mental Health Department (DSM) (1) Dipartimento di Salute Mentale, Azienda per l’Assistenza Sanitaria n.5 “Friuli Occidentale”, Pordenone (2) SOC Assistenza Farmaceutica, Azienda per l’Assistenza Sanitaria n.5 “Friuli Occidentale”, Pordenone Conclusions Currently, SGAs L.A.I. in Pordenone DSM are second line drugs usually given after one or more doses of oral antipsychotics, therefore chosen to treat “difficult” patients. These factors may explain the high rate of discontinuation and, in particular, the rate of inefficacy and non compliance. As reported in scientific literature, SGAs L.A.I. side effects seem to manifest quite frequently. These data suggest the heterogeneity of treatment strategies for young-adults with schizophrenia among the psychiatrists of the Department. Methods We analyzed the prescription of SGAs L.A.I. at Pordenone Mental Health Department D.S.M. from 2008 to 2015, considering patients aged 18 to 39 years. We examined: duration of treatment, discontinuation cause and previous therapy to L.A.I.(table 1) Per informazioni: [email protected] References 1. National Collaborating Centre for Mental Health. Psychosis and Schizophrenia in Adults: Treatment and Management. NICE Clinical Guideline 178. NICE, 2014 2. Agid O, Foussias G, Remington G Long-acting injectable antipsychotics in treatment of schizophrenia: their role in relapse prevention. Expert Opin. Pharmacother. 2010; 11(14) 3. Liebermann JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209-23 4. A.P.A. Practice guidelines for the treatment of patients with schizophrenia. Am J Psychiatry 1997; 154 (suppl. 4) : 1-63 5. Dolder CR. , Lacro JP., Dunn L.B., Jeste D.V., 2002. Antipsychotic medication adherence: is there a difference between atypical and atypical agents? Am. I . Psychiatry 159, 103-108. IV Incontro Nazionale dei Giovani Psichiatri, 4-5 maggio 2016 Ages n.patients 18-39 41 40-64 143 65+ 34 tot 218 Table 1. DSM AAS5: Patients with SGAs LAI therapies (ages) SGAs LAI n.patients Aripiprazole 1 Paliperidone 18 Risperidone 18 >1 LAI 4 Total 41 Table 2. DSM AAS5: Patients with SGAs LAI therapies (ages) On average, the SGAs L.A.I. is prescribed 3,83 years after the first contact with D.S.M.. Of 41 patients, 4 (9.8%) received SGAs L.A.I. as a first choice, while in 37 cases (90.2%) were later prescribed an oral AP treatment; In particular, 16 patients after using 1 oral AP, 9 patients after 2 oral AP, 12 patients after 3 or more oral AP (table 3). 13 patients (31.7%), have been previously treated by a typical LAI (table 4). n. of oral AP FGA SGA FGA and SGA total 0 4 1 1 15 0 16 2 0 3 6 9 3 + 0 3 9 12 total 1 21 15 41 n. patients previous first generation LAI 13 no previous first generation LAI 28 tot 41 Table 3. Previous oral therapy with AP Table 4. Previous first generation LAI In 19 patients SGAs L.A.I. treatment is still ongoing. SGAs L.A.I. was discontinued in 20 cases (44,4%). 6 patients were relocated to a different province and no data is available on the progress of the treatment. In 7 cases discontinuation was due to inefficacy, in 3 cases to side effects and in 8 cases to other causes (table 5). L.A.I. discontinuation n. patients % YES 20 44,4% NO 19 42,2% unknown (patient relocation) 6 13,3% Table 5. SGAs L.A.I. discontinuation Reason for discontinuation (%) 45% 15% 35% 5% 1 - disease remission 2 - inefficacy 3 - side effects 4 - other causes
Transcript of USING SGAS L.A.I. IN YOUNG ADULT SCHIZOPHRENIC … · USING SGAS L.A.I. IN YOUNG ADULT...
U S I N G S G A S L . A . I . I N Y O U N G A D U LT SCHIZOPHRENIC PATIENTS AT PORDENONE MENTAL HEALTH DEPARTMENTG.Commodari (1), B.Basso (2), A.Cassin (1)
Background Schizophrenia is a recurrent and chronic disease which requires a long term treatment. Antipsychotics (AP) can reduce relapse rates; non-adherence with such treatment is associated with both short-term and long-term negative consequences. Second Generation Antipsychotics (SGAs) represent the current standard of care for schizophrenia. SGAs are considered better tolerated than First Generation Antipsychotics (FGA), although non-adherence is not much different than conventional compounds. Long-acting injectable antipsychotics (L.A.I.) can prove useful for distinguishing poor adherence versus poor response, may alleviate problems of treatment adherence and allow a more constant plasma concentration thereby reducing the occurrence of relapse.
Results
The province of Pordenone has about 314.000 inhabitants and the D.S.M. is in charge of 884 patients with a diagnosis of schizophrenia. During the course of 8 years, 242 patients received a SGAs L.A.I. of which 41 were young-adults: 18 cases received Risperidone, 18 Paliperidone, 1 Aripiprazole, 4 cases Risperidone and Paliperidone (tab 2)
Aim of the study Our analysis focused on the prescription methods of SGAs L.A.I. in young adult patients at Pordenone Mental Health Department (DSM)
(1) Dipartimento di Salute Mentale, Azienda per l’Assistenza Sanitaria n.5 “Friuli Occidentale”, Pordenone (2) SOC Assistenza Farmaceutica, Azienda per l’Assistenza Sanitaria n.5 “Friuli Occidentale”, Pordenone
Conclusions
Currently, SGAs L.A.I. in Pordenone DSM are second line drugs usually given after one or more doses of oral antipsychotics, therefore chosen to treat “difficult” patients. These factors may explain the high rate of discontinuation and, in particular, the rate of inefficacy and non compliance. As reported in scientific literature, SGAs L.A.I. side effects seem to manifest quite frequently. These data suggest the heterogeneity of treatment strategies for young-adults with schizophrenia among the psychiatrists of the Department.
Methods We analyzed the prescription of SGAs L.A.I. at Pordenone Mental Health Department D.S.M. from 2008 to 2015, considering patients aged 18 to 39 years. We examined: duration of treatment, discontinuation cause and previous therapy to L.A.I.(table 1)
Per informazioni: [email protected]
References 1. National Collaborating Centre for Mental Health. Psychosis and Schizophrenia in Adults: Treatment and Management. NICE Clinical Guideline 178. NICE, 2014 2. Agid O, Foussias G, Remington G Long-acting injectable antipsychotics in treatment of schizophrenia: their role in relapse prevention. Expert Opin. Pharmacother. 2010; 11(14) 3. Liebermann JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209-23 4. A.P.A. Practice guidelines for the treatment of patients with schizophrenia. Am J Psychiatry 1997; 154 (suppl. 4) : 1-63 5. Dolder CR. , Lacro JP., Dunn L.B., Jeste D.V., 2002. Antipsychotic medication adherence: is there a difference between atypical and atypical agents? Am. I . Psychiatry 159, 103-108.
IV Incontro Nazionale dei Giovani Psichiatri, 4-5 maggio 2016
Ages n.patients18-39 4140-64 14365+ 34tot 218
Table 1. DSM AAS5: Patients with SGAs LAI therapies (ages)
SGAs LAI n.patients
Aripiprazole 1Paliperidone 18Risperidone 18>1 LAI 4
Total 41
Table 2. DSM AAS5: Patients with SGAs LAI therapies (ages)
On average, the SGAs L.A.I. is prescribed 3,83 years after the first contact with D.S.M.. Of 41 patients, 4 (9.8%) received SGAs L.A.I. as a first choice, while in 37 cases (90.2%) were later prescribed an oral AP treatment; In particular, 16 patients after using 1 oral AP, 9 patients after 2 oral AP, 12 patients after 3 or more oral AP (table 3). 13 patients (31.7%), have been previously treated by a typical LAI (table 4).
n. of oral AP FGA SGA
FGA and SGA total
0 4
1 1 15 0 16
2 0 3 6 9
3 + 0 3 9 12
total 1 21 15 41
n. patients
previous first generation LAI 13
no previous first generation LAI 28
tot 41
Table 3. Previous oral therapy with AP
Table 4. Previous first generation LAI
In 19 patients SGAs L.A.I. treatment is still ongoing. SGAs L.A.I. was discontinued in 20 cases (44,4%). 6 patients were relocated to a different province and no data is available on the progress of the treatment. In 7 cases discontinuation was due to inefficacy, in 3 cases to side effects and in 8 cases to other causes (table 5).
L.A.I. discontinuation n. patients %YES 20 44,4%NO 19 42,2%unknown (patient relocation) 6 13,3%
Table 5. SGAs L.A.I. discontinuation
Reason for discontinuation (%)
45%
15%
35%
5%
1 - disease remission2 - inefficacy3 - side effects4 - other causes
