Factors Associated With Treatment Initiation With Atypical Long-acting Injectable Antipsychotics Among Medicaid Patients With Schizophrenia

Objectives: Investigate demographic, clinical, and economic factors associated with treatment initiation of paliperidone palmitate (PP) and aripiprazole LAI (ALAI) in Medicaid patients with schizophrenia.

Methods: Adults with ≥1 medical or pharmacy claim for PP or ALAI from 1/1/2013 to 12/31/2016 were selected from the Truven Health MarketScan® Medicaid Database. The date of the first PP or ALAI claim was the index date. Patients were required to have ≥2 medical claims, on different days, for a schizophrenia diagnosis, and ≥12 months’ continuous health plan enrollment prior to index. Multivariable logistic regression was performed to determine the factors associated with PP vs ALAI initiation.

Results: The study included 5501 PP- and 1449 ALAI-initiated patients. Multivariable analyses showed that patients more likely to initiate PP vs ALAI were older, male, or African American (all P<0.01). Patients with obesity (OR: 0.84, 95% CI [0.716, 0.978]), posttraumatic stress disorder (OR: 0.76, 95% CI [0.626, 0.920]), or prior oral atypical antipsychotic use (OR: 0.65, 95% CI [0.547, 0.781]) were less likely to initiate PP; whereas patients with nonorganic psychoses (OR: 1.35, 95% CI [1.183, 1.550]) or prior injectable antipsychotics (OR: 1.26, 95% CI [1.088, 1.463]) were more likely to initiate PP vs ALAI. Patients with ≥2 all-cause hospitalizations were 1.37 times more likely to initiate PP vs ALAI (OR: 1.37, 95% CI [1.172, 1.591]).

Conclusions: Factors associated with initiating PP and ALAI were different. Notably, patients initiated on PP had greater prior use of medical services than ALAI patients.