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. 2019 Jun 13;14(6):e0218071.
doi: 10.1371/journal.pone.0218071. eCollection 2019.

Comparative effectiveness of second generation long-acting injectable antipsychotics based on nationwide database research in Hungary

P Takács  1 , P Czobor  2 , L Fehér  3 , J Gimesi-Országh  4 , P Fadgyas-Freyler  4 , M Bacskai  5 , P Rakonczai  5 , A Borsi  6 , R Hegyi  4 , T Németh  5 , J Sermon  6 , I Bitter  2
Affiliations

Comparative effectiveness of second generation long-acting injectable antipsychotics based on nationwide database research in Hungary

P Takács et al. PLoS One. .

Abstract

Background: Schizophrenia is a severe condition that affects approximately 1% of the population. Certain elements of antipsychotic treatment can only be examined in large population, thus the need for population-based real-world analyses has been increasing.

Patients and methods: Hungarian National Health Fund database includes all healthcare data of the population of Hungary. All patients diagnosed with schizophrenia between 01.01.2006 and 31.12.2015 were included in the study. We analyzed all patients with newly initiated second-generation antipsychotic during the inclusion period (01.01.2012-31.12.2013). Patients were followed for 2 years. All-cause treatment discontinuation served as the primary outcome of the study. Patients with newly initiated long-acting injectable treatments were further investigated in stratified analyses based on their previous treatment.

Results: 106,624 patients had schizophrenia diagnosis during the study period. 12,232 patients met the inclusion criteria for newly initiating second-generation antipsychotic during the inclusion period. The proportion of patients still on treatment after 1 year for oral treatments varied between 17% (oral risperidone) and 31% (oral olanzapine) while the analogous data for long acting injectables were between 32% (risperidone long acting) and 64% (paliperidone long acting one monthly). The 2-year data were similarly in favor of long-actings. Median time to discontinuation in the oral group varied between 57 days (clozapine) and 121 days (olanzapine). The median time to discontinuation for long-actings was significantly longer: between 176 and 287 days; in case of paliperidone long acting, median was not reached during the observation period. Patients receiving long-acting treatment switched from another long-acting remained on the newly initiated treatment significantly longer than those switched from orals.

Conclusion: Our results indicate the superiority of second generation long-acting antipsychotics with regard to rates of treatment discontinuation and periods of persistence to the assigned medication.

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Conflict of interest statement

Four authors (P Takács, A Borsi, L Fehér and J Sermon) are full time employees of different affiliates of Janssen, a Johnson and Johnson Owned company. P. Takács and L. Feher are employees of Janssen-Cilag Kft. J Sermon is an employee of Janssen Pharmaceutica NV. A. Borsi is an employee of Janssen-Cilag Limited. All of the four Janssen employees hold common shares and Johnson and Johnson, the mother company of Janssen. Four authors (M Bacskai, P Rakonczai, R Hegyi and T Németh) were employees of a commercial organization at the time of the research- an independent data research company, Healthware Consulting Kft, which received funding for contribution to the study design and data analyses from Janssen. P Rakonczai is currently employed by Evidera Kft. P Fadgyas-Freyler and J Gimesi-Országh. were employees of the Hungarian National Health Insurance Fund (NHIF) at the time of the study. J Gimesi-Országh currently works as an independent consultant while P Fadgyas-Freyler is still an employee of NHIF. I Bitter has been an advisory board member/consultant/lecturer in the last 5 years for Angelini, EGIS, Eli Lilly, Janssen, Lundbeck, Pierre Fabré, Gedeon Richter and Servier. These competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products to declare. All other authors declare no competing interests.

Figures

Fig 1
Fig 1. Patient inclusion and study design.
Fig 2
Fig 2. Kaplan-Meier survival of PP1M treated subgroups with 60 days grace period.
See this image and copyright information in PMC

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