Factors Associated with the Initiation of Long-Acting Injectable Paliperidone Palmitate Versus Aripiprazole Among Medicaid Patients with Schizophrenia: An Observational Study
Factors underlying the selection of antipsychotics for patients with schizophrenia are poorly understood. This study investigated variables associated with initiation of treatment with the long-acting injectables paliperidone palmitate (LAI-PP) and aripiprazole LAI (LAI-AP) in Medicaid patients with schizophrenia.
Adults with at least one medical or pharmacy claim for LAI-PP or LAI-AP from 1 January 2013 to 31 December 2016 were selected from the IBM® MarketScan® Medicaid Database. The date of the first LAI-PP or LAI-AP claim was the index date. Patients who had at least two medical claims, on different days, for a schizophrenia diagnosis and at least 12 months of continuous health plan enrollment prior to index date were included in the analysis. Multivariable logistic regression was performed to determine the factors associated with the initiation of LAI-PP versus LAI-AP.
Of included patients, 5501 initiated LAI-PP and 1449 initiated LAI-AP. Patients more likely to initiate LAI-PP versus LAI-AP were older, male, or African American (all p < 0.01). Patients with obesity (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.71, 0.98), post-traumatic stress disorder (OR 0.76; 95% CI 0.63, 0.92), or prior oral antipsychotic use (OR 0.66; 95% CI 0.55, 0.79) were less likely to initiate LAI-PP; whereas, patients with nonorganic psychoses (OR 1.35; 95% CI 1.18, 1.55) or prior use of other injectable antipsychotics (OR 1.26; 95% CI 1.09, 1.47) were more likely to initiate LAI-PP versus LAI-AP. Patients with at least two all-cause hospitalizations were 1.37 times more likely to initiate LAI-PP vs LAI-AP (OR 1.37; 95% CI 1.18, 1.60).
Factors associated with initiating LAI-PP and LAI-AP differed. Notably, patients who initiated LAI-PP had greater prior use of medical services than LAI-AP patients. Understanding prescribing practices may help optimize treatment strategies and improve disease management.
Janssen Scientific Affairs, LLC.
KeywordsAripiprazole Claims database Long-acting injectables Medicaid Mental health Paliperidone palmitate Real-world evidence Schizophrenia
This study was sponsored by Janssen Scientific Affairs, LLC. The study sponsor also funded the journal’s article processing charges. All authors had full access to all the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
Medical Writing and Editorial Assistance
Editorial assistance in the preparation of this article was provided by Prabhakar Pandey of SIRO Clinpharm Pvt. Ltd. Support for this assistance was funded by Janssen Scientific Affairs, LLC.
All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work, and have given their approval for this version to be published.
Conception and design: QC, ACE, CP, OT, EK. Collection and assembly of data: QC. Data analysis and interpretation: QC, OT. Manuscript writing: All authors. Final approval of manuscript: All authors.
Qian Cai is an employee of and holds stock in Johnson & Johnson. Charmi Patel is an employee of and holds stock in Johnson & Johnson. Edward Kim is an employee of and holds stock in Johnson & Johnson. Nancy Connolly is an employee of and holds stock in Johnson & Johnson. Ozgur Tunceli is an employee of and holds stock in Johnson & Johnson. Antoine C El Khoury is an employee of and holds stock in Johnson & Johnson.
Compliance with Ethics Guidelines
All data were de-identified and fully complied with the US Health Insurance Portability and Accountability Act; therefore, this study was exempted from institutional review board review .
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
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