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Paliperidone Palmitate May Delay First Major Treatment Failure in Recent-Onset Schizophrenia
Major treatment failure occurred at a lower rate in patients with recent-onset schizophrenia or schizophreniform disorder treated with the long-acting injectable (LAI) antipsychotic paliperidone palmitate (PP) compared with oral antipsychotics, according to a study published in Schizophrenia Research.
“Initiation of PP during the early stages of schizophrenia spectrum disorders significantly delayed time to hospitalization and arrest/incarceration, outcomes with important personal and economic consequences, compared with oral antipsychotics during this 18-month study,” wrote researchers from Jansen Pharmaceuticals and the University of California at Los Angeles Departments of Psychiatry and Psychology.
The finding stemmed from a post hoc analysis of the Disease Recovery Evaluation and Modification (DREaM) study. The open-label trial, which focused on patients with recent-onset schizophrenia or schizophreniform disorder, consisted of 3 parts. Part I was a 2-month oral run-in phase. Part II was a 9-month disease progression phase that randomized patients to treatment with PP or oral antipsychotics. In Part III, patients were rerandomized to stay with their previous treatment or to switch to PP for an additional 9 months.
Events such as arrest, incarceration, or psychiatric hospitalization were considered indicators of major treatment failure.
According to the study, major treatment failure occurred in 12.8% of patients in the PP group and 13.4% in the oral antipsychotic group during Part II. However, significant differences in the rate of major treatment failure by treatment group emerged in Part III. Proportions of major treatment failure were 0% in the PP/PP group, 3.5% in the oral antipsychotic/PP group, and 15.9% in the oral antipsychotic/oral antipsychotic group.
An 18-month extended disease progression analysis that focused exclusively on patients who stayed on the same treatment throughout Parts II and III showed rates of major treatment failure were 10.2% with PP compared with 25.4% with oral antipsychotics.
Safety findings were similar between groups, the study found.
“The findings of this post hoc analysis add to the body of literature demonstrating the safety and efficacy of LAI antipsychotics,” researchers wrote, “and support the rationale for earlier implementation of LAI antipsychotics in the disease course of schizophrenia spectrum disorders.”
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