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Psych Congress  

Predicting Factors for Reaching Stabilized Maintenance with Once-Monthly Paliperidone Palmitate in Medicaid Patients with Schizophrenia

Authors  
Erik Muser, PharmD, MPH
Dominic Pilon, MA
Bruno Emond, MA
Yongling Xiao, PhD
Tony Amos, PharmD
Patrick Lefebvre, MA
Carmela Benson, MS, MSHP
Sponsor  
Janssen Scientific Affairs, LLC

BACKGROUND: With FDA approval of every three month paliperidone palmitate (PP3M), understanding patients stabilized on once-monthly paliperidone palmitate (PP1M) that could be transitioned to PP3M is important. OBJECTIVES: Identify predicting factors associated with reaching stabilized maintenance therapy among schizophrenia patients treated with PP1M. METHODS: A retrospective (07/2008-03/2014) database analysis of Medicaid beneficiaries diagnosed with schizophrenia and initiated on PP1M (index date) was conducted. Baseline characteristics were assessed during the 12-month pre-index period. Reaching stabilized maintenance was defined as ≥3 consecutive PP1M claims with the same dose strength after the first two initiation doses and ≤60 days between claims. A stepwise logistic regression was used to identify the predictors of reaching stabilized maintenance without adjustment for multiplicity. RESULTS: At baseline, relative to non-stabilized patients (N=2,470), patients reaching stabilized maintenance (N=2,012) were more likely to be adherent to antipsychotics (APs) (Proportion of days covered ≥80%: 46% vs. 27%, P<0.001), and were less likely to have dual or capitated coverage (55% vs. 73%, P<0.001). Prior use of atypical long-acting injectables (LATs) (odds ratio [OR]=1.38, P<0.001), and prior adherence to APs (OR=1.70, P<0.001) increased the likelihood of reaching stabilized maintenance. Conversely, hospitalization occuring within 30 days prior to PP1M initiation (OR=0.83, P=0.044) and increasing number of prior APs received (OR=0.94, P=0.035) were factors associated with a lower likelihood of reaching stabilized maintenance. CONCLUSIONS: Patients with prior adherence to AP, prior atypical LAT use, fewer unique APs used, and without hospitalization 30 days prior to PP1M initiation were more likely to reach stabilized maintenance.

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