Patients' Preference for Long-Acting Injectable versus Oral Antipsychotics in Schizophrenia: Results from the Patient-Reported Medication Preference Questionnaire

Clifton Blackwood; Panna Sanga; Isaac Nuamah; Alexander Keenan; Arun Singh; Maju Mathews; Srihari Gopal

doi:10.2147/PPA.S251812

Patients' Preference for Long-Acting Injectable versus Oral Antipsychotics in Schizophrenia: Results from the Patient-Reported Medication Preference Questionnaire

Patient Prefer Adherence. 2020 Jul 2:14:1093-1102. doi: 10.2147/PPA.S251812. eCollection 2020.

Authors

Clifton Blackwood¹, Panna Sanga², Isaac Nuamah³, Alexander Keenan⁴, Arun Singh², Maju Mathews², Srihari Gopal²

Affiliations

¹ Penn State University, Abington, PA, USA.
² Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA.
³ Clinical Biostatistics, Janssen Research & Development, LLC, Titusville, NJ, USA.
⁴ Health Economics and Market Access, Janssen Research & Development, LLC, Titusville, NJ, USA.

Abstract

Introduction: Understanding patients' preferences for long-acting injectable (LAI) or oral antipsychotics (pills) could help reduce potential barriers to LAI use in schizophrenia.

Methods: Post hoc analyses were conducted from a double-blind, randomized, non-inferiority study (NCT01515423) of 3-monthly vs 1-monthly paliperidone palmitate in patients with schizophrenia. Data from the Medication Preference Questionnaire, administered on day 1 (baseline; open-label stabilization phase), were analyzed. The questionnaire includes four sets of items: 1) reasons for general treatment preference based on goals/outcomes and preference for LAI vs pills based on 2) personal experience, 3) injection-site (deltoid vs gluteal), 4) dosing frequency (3-monthly vs 1-monthly). A logistic regression analysis was performed to assess the effect of baseline variables on preference (LAIs or pills).

Results: Data from 1402 patients were available for analysis. Patients who preferred LAIs recognized these outcomes as important: "I feel more healthy" (57%), "I can get back to my favorite activities" (56%), "I don't have to think about taking my medicines" (54%). Most common reasons for medication preference (LAI vs pills) were: "LAIs/pills are easier for me" (67% vs 18%), "more in control/don't have to think about taking medicine" (64% vs 14%), "less pain/sudden symptoms" (38% vs 18%) and "less embarrassed" (0% vs 46%). Majority of patients (59%) preferred deltoid over gluteal injections (reasons: faster administration [63%], easier [51%], less embarrassing [44%]). In total, 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing citing reasons: fewer injections [96%], fewer injections are less painful [84%], and fewer doctor visits [80%]. From logistic regression analysis, 77% of patients preferred LAI over pills; culture and race appeared to play a role in this preference.

Conclusion: Patients who preferred LAI antipsychotics prioritized self-empowerment and quality-of-life-related goals. When given the option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.

Keywords: long-acting injectable antipsychotics; oral antipsychotics; paliperidone palmitate; patient preference; quality-of-life.