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首页> 外文期刊>Patient Preference and Adherence >Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic
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Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

机译：从第一代或第二代长效注射抗精神病药开始，对精神分裂症的医疗补助患者进行治疗

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Background: Poor antipsychotic (AP) adherence is a key issue in patients with schizophrenia. First-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) long-acting injectable therapies (LAI) may improve adherence compared to oral antipsychotics (OAP). The objective of the study was to compare treatment adherence and persistence in Medicaid patients with schizophrenia initiated on first-generation long-acting injectable therapies (FGA-LAI) or second-generation long-acting injectable therapies (SGA-LAI) versus OAP. Methods: Adults with schizophrenia initiated on FGA-LAI, SGA-LAI, or OAP on or after January 2010 were identified using a six-state Medicaid database (January 2009– March 2015). Outcomes were assessed during the 12 months following treatment initiation. Index medication adherence was assessed using the proportion of days covered ≥80%, while persistence was assessed as no gap of ≥30, ≥60, or ≥90 days between days of supply. Outcomes were compared between FGA/SGA-LAI and OAP cohorts using chi-squared tests and adjusted odds ratios (OR). Results: During follow-up, AP polypharmacy was more common in FGA-LAI patients (N=1,089; 36%; P =0.029) and less common in SGA-LAI patients (N=2,209; 27%; P <0.001) versus OAP patients (N=20,478; 33%). After adjustment, SGA-LAI patients had 24% higher odds of adherence at 12 months (OR: 1.24; P <0.001), in contrast to FGA-LAI patients who had 48% lower odds of adherence (OR: 0.52; P <0.001) relative to OAP patients. SGA-LAI patients were more likely to be persistent (no gap ≥60 days) at 12 months than OAP patients (37% vs 30%; P <0.001), but not FGA-LAI patients (31% vs 30%; P =0.776). In comparison to OAP patients, SGA-LAI patients had 46% higher adjusted odds of persistence (no gap ≥60 days; OR: 1.46; P <0.001), while FGA-LAI patients were not significantly different (OR: 0.95; P =0.501). Conclusion: Medicaid patients initiated on SGA-LAI demonstrated better treatment adherence and persistence compared to OAP patients, while those initiated on FGA-LAI did not show significant improvement in adherence or persistence and had more AP polypharmacy relative to OAP patients. These findings suggest the potential value of SGA-LAI in the treatment of schizophrenia.
机译：背景：抗精神病药物（AP）依从性差是精神分裂症患者的关键问题。与口服抗精神病药（OAP）相比，第一代抗精神病药（FGA）和第二代抗精神病药（SGA）长效注射疗法（LAI）可能会改善依从性。该研究的目的是比较第一代长效注射疗法（FGA-LAI）或第二代长效注射疗法（SGA-LAI）与OAP引发的精神分裂症医疗补助患者的治疗依从性和持久性。方法：使用六州医疗补助数据库（2009年1月至2015年3月）确定2010年1月或之后通过FGA-LAI，SGA-LAI或OAP引发的精神分裂症成人。在治疗开始后的12个月内评估结果。使用覆盖率≥80％的天数评估指标药物依从性，而持续性评估为在供应天数之间无间隔≥30，≥60或≥90天。使用卡方检验和调整的优势比（OR）比较FGA / SGA-LAI和OAP队列的结果。结果：在随访过程中，与FGA-LAI患者相比，AP多药治疗更为常见（N = 1,089; 36％; P = 0.029），而在SGA-LAI患者中，AP多药治疗较少（N = 2,209; 27％; P <0.001）。 OAP患者（N = 20,478; 33％）。调整后，SGA-LAI患者在12个月时的依从机率高24％（OR：1.24; P <0.001），而FGA-LAI患者的依从机率低48％（OR：0.52; P <0.001 ）相对于OAP患者。与OAP患者相比，SGA-LAI患者在12个月时更有可能持续存在（无间隙≥60天）（37％vs 30％; P <0.001），但不是FGA-LAI患者（31％vs 30％; P = 0.776）。与OAP患者相比，SGA-LAI患者的调整后持续几率高出46％（无间隙≥60天; OR：1.46; P <0.001），而FGA-LAI患者无显着差异（OR：0.95; P = 0.501）。结论：与OAP患者相比，以SGA-LAI开始的医疗补助患者表现出更好的治疗依从性和持久性，而以FGA-LAI发起的患者则没有显示出明显的依从性和持久性改善，并且与OAP患者相比，AP多药治疗的机会更多。这些发现表明SGA-LAI在精神分裂症治疗中的潜在价值。

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