Predictors of relapse in patients with schizophrenia and schizoaffective disorders in real-world data from a large health system

Supported by funding from Sumitomo Pharma America, Inc. and Otsuka Pharmaceuticals Development & Commercialization, Inc. Purpose: This study utilized a large sample of Midwestern healthcare patients diagnosed with schizophrenia and schizoaffective disorders to identify demographic, clinical, and utilization characteristics that predicted relapse. Methods: This retrospective study includes EHR data from patients between October 15, 2016, and December 31, 2021. Patients’ first encounter with a schizophrenia or schizoaffective diagnosis in this timeframe was defined as their index date, and encounters up to three years post-index date were explored. Patient-level variables within the first six months of follow-up were assessed as potential relapse predictors, and first relapse at or after six months of follow-up within the system was explored as the outcome. Relapse was defined as occurrence of any behavioral health-related emergency room or inpatient encounter after six months of follow-up within the system. Potential variables assessed include patient characteristics at index date, comorbidities, encounter settings, medication classes, and outcomes experienced. Results: The study included 8,119 patients with 325,745 follow-up encounters, with an average of 28.0 months of follow-up data post-index date. Among all patients, 30.5% experienced relapse. Adjusted analysis revealed patients who relapsed were more likely to be younger, identify as Hispanic or Latino or Non-Hispanic (NH) Pacific Islander vs. NH White; have Medicare or Medicaid vs. Private insurance; have diagnoses of substance use and EPS, utilize more ER and BH inpatient encounters, experience more prior relapse, and receive more LAI prescriptions. Conclusions: An algorithm of these variables could be used to proactively assess relapse risk among patients with schizophrenia to implement appropriate relapse prevention plans.