Limits...
Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence.

Kelin K, Lambert T, Brnabic AJ, Newton R, Ye W, Escamilla RI, Chen KP, Don L, Montgomery W, Karagianis J, Ascher-Svanum H - Patient Prefer Adherence (2011)

Bottom Line: During the study, patients' clinical and functional status improved significantly and service use was low.Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study.The discrepancy between the physicians' perception of their patient's medication adherence and the patients' self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia;

ABSTRACT

Background: This study aimed to improve physicians' understanding of the treatment circumstances and needs of outpatients with schizophrenia at risk of nonadherence, by naturalistically assessing antipsychotic treatment patterns, clinical outcomes, and health care service use in this little-studied patient population.

Methods: In this one-year, prospective, multicenter, noninterventional, observational study, patients considered at risk of nonadherence by their physicians were switched from their primary oral antipsychotic to another oral or a depot antipsychotic at study entry. All cause treatment discontinuation (antipsychotic switch, augmentation, or discontinuation) during the study was assessed using Kaplan-Meier survival analyses and descriptive statistics. Patients' illness severity, quality of life, attitude towards medication, patient-reported adherence, and health care resource utilization were assessed during the study.

Results: Of the 406 enrolled patients, 43 (10.6%) were switched to depot and 363 (89.4%) were switched to oral antipsychotics at study entry. During the study, 99 (24.4%) patients switched, augmented, or discontinued their antipsychotic (all cause treatment discontinuation). Of the 99 patients who switched, augmented, or discontinued their antipsychotic, 8 (18.6%) were taking depot and 91 (25.0%) were taking oral antipsychotics. These patients were switched to either depot (n = 15) or oral (n = 78) antipsychotics, or discontinued their antipsychotic medication (n = 6). Inadequate response was the most frequently reported reason for medication discontinuation. During the study, patients' clinical and functional status improved significantly and service use was low. Most patients considered themselves to be adherent at study entry, and this favorable self-perception increased during the study (from 68.5% to 88.1%).

Conclusion: Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study. The discrepancy between the physicians' perception of their patient's medication adherence and the patients' self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.

No MeSH data available.


Related in: MedlinePlus

Twelve-month Kaplan–Meier survival curve (n = 406) for all cause treatment discontinuation (event, n = 99; censored, n = 307). Time to discontinuation was calculated from the date of study entry to the date of the first all cause treatment discontinuation. For the survival analyses, patients were censored if they had not switched, augmented, or discontinued their antipsychotic medication at 365 days, if they had completed the study, or if they discontinued from the study for any reason. Censored patients are denoted by •. Median Kaplan–Meier estimates could not be calculated because the proportion of patients who had changed their medication during the study did not reach 50% at 12 months.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3105874&req=5

f2-ppa-5-213: Twelve-month Kaplan–Meier survival curve (n = 406) for all cause treatment discontinuation (event, n = 99; censored, n = 307). Time to discontinuation was calculated from the date of study entry to the date of the first all cause treatment discontinuation. For the survival analyses, patients were censored if they had not switched, augmented, or discontinued their antipsychotic medication at 365 days, if they had completed the study, or if they discontinued from the study for any reason. Censored patients are denoted by •. Median Kaplan–Meier estimates could not be calculated because the proportion of patients who had changed their medication during the study did not reach 50% at 12 months.

Mentions: Of the 406 patients enrolled in the study, 99 (24.4%) switched, augmented, or discontinued their antipsychotic medication during the 12-month study period (all cause treatment discontinuation). As the proportion of patients who switched, augmented, or discontinued their medication did not reach 50% during the study, the median survival time for all cause treatment discontinuation could not be estimated from the Kaplan–Meier survival analysis (Figure 2). However, the 25th percentile (95% CI) Kaplan–Meier estimate could be estimated at 310 (208, not applicable) days for all cause treatment discontinuation. In lieu of median Kaplan–Meier estimates, the median time to treatment discontinuation was summarized using descriptive statistics as 102 (2, 365) days (n = 99). Inadequate response (35.9%) was the most frequently reported reason for treatment discontinuation (Table 2). Other frequently reported reasons were lack of compliance (14.1%), investigator decision (13.0%), and upon patient’s request (10.9%).


Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence.

Kelin K, Lambert T, Brnabic AJ, Newton R, Ye W, Escamilla RI, Chen KP, Don L, Montgomery W, Karagianis J, Ascher-Svanum H - Patient Prefer Adherence (2011)

Twelve-month Kaplan–Meier survival curve (n = 406) for all cause treatment discontinuation (event, n = 99; censored, n = 307). Time to discontinuation was calculated from the date of study entry to the date of the first all cause treatment discontinuation. For the survival analyses, patients were censored if they had not switched, augmented, or discontinued their antipsychotic medication at 365 days, if they had completed the study, or if they discontinued from the study for any reason. Censored patients are denoted by •. Median Kaplan–Meier estimates could not be calculated because the proportion of patients who had changed their medication during the study did not reach 50% at 12 months.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3105874&req=5

f2-ppa-5-213: Twelve-month Kaplan–Meier survival curve (n = 406) for all cause treatment discontinuation (event, n = 99; censored, n = 307). Time to discontinuation was calculated from the date of study entry to the date of the first all cause treatment discontinuation. For the survival analyses, patients were censored if they had not switched, augmented, or discontinued their antipsychotic medication at 365 days, if they had completed the study, or if they discontinued from the study for any reason. Censored patients are denoted by •. Median Kaplan–Meier estimates could not be calculated because the proportion of patients who had changed their medication during the study did not reach 50% at 12 months.
Mentions: Of the 406 patients enrolled in the study, 99 (24.4%) switched, augmented, or discontinued their antipsychotic medication during the 12-month study period (all cause treatment discontinuation). As the proportion of patients who switched, augmented, or discontinued their medication did not reach 50% during the study, the median survival time for all cause treatment discontinuation could not be estimated from the Kaplan–Meier survival analysis (Figure 2). However, the 25th percentile (95% CI) Kaplan–Meier estimate could be estimated at 310 (208, not applicable) days for all cause treatment discontinuation. In lieu of median Kaplan–Meier estimates, the median time to treatment discontinuation was summarized using descriptive statistics as 102 (2, 365) days (n = 99). Inadequate response (35.9%) was the most frequently reported reason for treatment discontinuation (Table 2). Other frequently reported reasons were lack of compliance (14.1%), investigator decision (13.0%), and upon patient’s request (10.9%).

Bottom Line: During the study, patients' clinical and functional status improved significantly and service use was low.Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study.The discrepancy between the physicians' perception of their patient's medication adherence and the patients' self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia;

ABSTRACT

Background: This study aimed to improve physicians' understanding of the treatment circumstances and needs of outpatients with schizophrenia at risk of nonadherence, by naturalistically assessing antipsychotic treatment patterns, clinical outcomes, and health care service use in this little-studied patient population.

Methods: In this one-year, prospective, multicenter, noninterventional, observational study, patients considered at risk of nonadherence by their physicians were switched from their primary oral antipsychotic to another oral or a depot antipsychotic at study entry. All cause treatment discontinuation (antipsychotic switch, augmentation, or discontinuation) during the study was assessed using Kaplan-Meier survival analyses and descriptive statistics. Patients' illness severity, quality of life, attitude towards medication, patient-reported adherence, and health care resource utilization were assessed during the study.

Results: Of the 406 enrolled patients, 43 (10.6%) were switched to depot and 363 (89.4%) were switched to oral antipsychotics at study entry. During the study, 99 (24.4%) patients switched, augmented, or discontinued their antipsychotic (all cause treatment discontinuation). Of the 99 patients who switched, augmented, or discontinued their antipsychotic, 8 (18.6%) were taking depot and 91 (25.0%) were taking oral antipsychotics. These patients were switched to either depot (n = 15) or oral (n = 78) antipsychotics, or discontinued their antipsychotic medication (n = 6). Inadequate response was the most frequently reported reason for medication discontinuation. During the study, patients' clinical and functional status improved significantly and service use was low. Most patients considered themselves to be adherent at study entry, and this favorable self-perception increased during the study (from 68.5% to 88.1%).

Conclusion: Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study. The discrepancy between the physicians' perception of their patient's medication adherence and the patients' self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.

No MeSH data available.


Related in: MedlinePlus