Relapse in Adequately Versus Not Adequately Treated Black or African American Patients With Schizophrenia Transitioned to Paliperidone Palmitate Once-Every-3-Months Injection: A Retrospective Analysis

Abstract: Purpose: Paliperidone palmitate once-every-3-months (PP3M), a long-acting injectable antipsychotic, is indicated for adults with schizophrenia adequately treated (AT) with paliperidone palmitate once-monthly (PP1M) for ≥4 months and in whom the last 2 PP1M doses were the same. This retrospective real-world cohort study assessed outcomes in Black or African American (Black/AA) patients AT versus not adequately treated (NAT) with PP1M prior to PP3M transition. Methods: Data from the MarketScan® Multi-State Medicaid Database (June 2015 to December 2020) for patients ≥18 years with ≥1 schizophrenia diagnosis claim before and/or at index date (first PP3M prescription record) and continuous insurance plan enrollment ≥12 months before/after index date were analyzed. Two PP3M patient cohorts were generated using propensity score matching: AT (PP1M for ≥4 months [≥5 injections], with the same last 2 doses) and NAT (≤2 PP1M injections). Rates of first relapse and time to first relapse (TtFR) were compared between cohorts. TtFR was estimated using Kaplan-Meier survival curves and differences examined using log-rank test statistics; hazard ratio was calculated using Cox proportional hazards models. Results: A total of 592 Black/AA patients were matched (AT: 296, NAT: 296). Relapse rate was significantly lower in the AT (15.2%) versus NAT cohort (23.0%), P=0.0135. Risk of relapse decreased by 37% for AT versus NAT patients (hazard ratio, 0.63; 95% CI, 0.43-0.91). Inpatient psychiatric hospitalization accounted for 71%-74% of relapses in each group. Conclusion: Adequate treatment with PP1M before transitioning to PP3M was associated with significantly lower relapse rates and delayed TtFR in Black/AA patients with schizophrenia.Short Description: Black or African American patients who were adequately treated (AT) and not adequately treated (NAT) for schizophrenia with once-monthly paliperidone palmitate (PP1M) before transitioning to once-every-3-months paliperidone palmitate (PP3M) injection were evaluated using the MarketScan® Multi-State Medicaid Database. Relapse rate and risk of relapse were significantly lower in the AT cohort compared with the NAT cohort. Adequate treatment with PP1M before transitioning to PP3M improves clinical outcomes among Black or African American patients with schizophrenia.Name of Sponsoring Organization(s): Janssen Scientific Affairs, LLC