BACKGROUND: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses.OBJECTIVE: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors.METHODS: The STAR Network 'Depot Study' was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively.RESULTS: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4-44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3-43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4-84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6-40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6-27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742-0.981; p=0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003-4.634; p=0.049).CONCLUSIONS: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation.

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Bortolaso, Paola
Investigation
;
Callegari, Camilla
Supervision
;
Buzzi, Aldo Emanuele
Investigation
;
Calzolari, Roberta
Investigation
;
Caselli Ivano
Investigation
;
Ielmini, Marta
Investigation
;
Milano, Anna
Investigation
;
Poloni, Nicola
Investigation
;
Zizolfi, Daniele
Investigation
;
Alberini, Gabrio
Investigation
;
Cazzamalli, Sara
Investigation
;
Paronelli, Chiara
Investigation
;
Piantanida, Silvia
Investigation
;
Lucchi, Sara;Verrengia, Enrica;Rossi, Giuseppe;
2021

Abstract

BACKGROUND: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses.OBJECTIVE: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors.METHODS: The STAR Network 'Depot Study' was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively.RESULTS: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4-44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3-43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4-84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6-40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6-27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742-0.981; p=0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003-4.634; p=0.049).CONCLUSIONS: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation.
https://doi.org/10.1007/s40263-021-00809-w
he STAR Network ‘Depot Study’ prospectively followed 394 subjects initiating treatment with long-acting injections (LAIs) of antipsychotics under naturalistic conditions for 12 months. LAI discontinuation was frequent in everyday clinical practice in Italy, occurring in almost 40% of the entire sample; side efects, participant refusal to continue LAIs and LAIs no longer being required were the most frequently reported reasons for discontinuation. Paliperidone LAI and aripiprazole LAI were the least discontinued medications (33.9 and 35.4%, respectively), whereas more than half of participants initiating risperidone LAI and olanzapine LAI discontinued during the 12 months of follow-up (51.4 and 62.5%, respectively). In multivariate analysis, being prescribed olanzapine LAI and poor medication adherence at baseline were signifcantly associated with higher discontinuation risk.
Bertolini, Federico; Ostuzzi, Giovanni; Pievani, Michela; Aguglia, Andrea; Bartoli, Francesco; Bortolaso, Paola; Callegari, Camilla; Caroleo, Mariarita; Carrà, Giuseppe; Corbo, Mariangela; D'Agostino, Armando; De Fazio, Pasquale; Magliocco, Fabio; Martinotti, Giovanni; Ostinelli, Edoardo Giuseppe; Piccinelli, Marco Piero; Tedeschi, Federico; Barbui, Corrado; Boschello, Filippo; Gastaldon, Chiara; Mazzi, Maria Angela; Nosé, Michela; Papola, Davide; Perini, Giovanni; Piccoli, Alberto; Pievani, Michela; Purgato, Marianna; Ruggeri, Mirella; Tedeschi, Federico; Terlizzi, Samira; Turrini, Giulia; Nmagliocco, Fabio; Rafaele, Gaetano; Cavallotti, Simone; Chirico, Margherita; Ferrato, Farida; Limosani, Ivan; Mastromo, Daniele; Monzani, Emiliano; Porcellana, Matteo; Restaino, Francesco; Annese, Pasqua Maria; Bolognesi, Simone; Cerretini, Massimiliano; De Capua, Alberto; Debolini, Sara; Del Zanna, Maria; Fargnoli, Francesco; Giannini, Alessandra; Luccarelli, Livia; Lucii, Claudio; Pierantozzi, Elisa; Tozzi, Fiorella; Bardicchia, Francesco; Cardamone, Giuseppe; Facchi, Edvige; Magnani, Nadia; Soscia, Federica; Biancosino, Bruno; Zotos, Spyridon; Giacomin, Marzio; Pompei, Francesco; Spano, Mariangela; Zonta, Filippo; Buzzi, Aldo Emanuele; Calzolari, Roberta; Caselli, Ivano; Diurni, Marcello; Giana, Edoardo; Ielmini, Marta; Milano, Anna; Poloni, Nicola; Sani, Emanuele; Zizolfi, Daniele; Alberini, Gabrio; Cazzamalli, Sara; Costantini, Chiara; Di Caro, Angela; Paronelli, Chiara; Piantanida, Silvia; Papalini, Alessandro; Barbanti, Silvia Veronica; D’Ippolito, Chiara; Gozzi, Mauro; Moretti, Valentina; Campese, Ornella; Di Capro, Lucia; Di Giannantonio, Massimo; Fiori, Federica; Lorusso, Marco; Mancini, Valerio; Viceconte, Daniela; Calandra, Carmela; Luca, Maria; Signorelli, Maria Salvina; Suraniti, Francesco; Balzarro, Beatrice; Boncompagni, Giancarlo; Caretto, Valentina; Emiliani, Roberta; Lupoli, Pasqualino; Menchetti, Marco; Rossi, Eugenio; Storbini, Viviana; Tarricone, Ilaria; Terzi, Laura; Boso, Marianna; Catania, Cristina; De Paoli, Giuseppe; Risaro, Paolo; Aspesi, Flora; Bava, Mattia; Bono, Adele; Brambilla, Giulia; Castagna, Gloria; Lucchi, Sara; Nava, Roberto; Provenzi, Milena; Tabacchi, Tommaso; Tremolada, Martina; Verrengia, Enrica; Barchiesi, Michela; Oriani, Maria Ginevra; Pacetti, Monica; Ferro, Maurizio; Ghio, Lucio; Beneduce, Rossella; Lafranchini, Laura; Magni, Laura Rosa; Rossi, Giuseppe; Tura, Giovanni Battista; Addeo, Lelio; Balletta, Giovanni; De Vivo, Elisa; Di Benedetto, Rossella; Parise, Fricchione Vincenzo; Carpiniello, Bernardo; Pinna, Federica; Pecile, Damiano; Mattei, Chiara; Bonavigo, Tommaso; Pascolo Fabrici, Elisabetta; Panarello, Sofia; Peresson, Giulia; Vitucci, Claudio; Pacetti, Monica; Gardellin, Francesco; Strizzolo, Stefania; Cossetta, Edoardo; Fizzotti, Carlo; Moretti, Daniele; Di Gregorio, Luana; Sozzi, Francesca; Colli, Giuseppe; La Barbera, Daniele and Sabrina Laurenzi (Civitanova Marche).
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11383/2110084
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