Patients' Preference for Long-Acting Injectable versus Oral Antipsychotics in Schizophrenia: Results from the Patient-Reported Medication Preference Questionnaire

Clifton Blackwood, Panna Sanga, Isaac Nuamah, Alexander Keenan, Arun Singh, Maju Mathews, Srihari Gopal, Clifton Blackwood, Panna Sanga, Isaac Nuamah, Alexander Keenan, Arun Singh, Maju Mathews, Srihari Gopal

Abstract

Introduction: Understanding patients' preferences for long-acting injectable (LAI) or oral antipsychotics (pills) could help reduce potential barriers to LAI use in schizophrenia.

Methods: Post hoc analyses were conducted from a double-blind, randomized, non-inferiority study (NCT01515423) of 3-monthly vs 1-monthly paliperidone palmitate in patients with schizophrenia. Data from the Medication Preference Questionnaire, administered on day 1 (baseline; open-label stabilization phase), were analyzed. The questionnaire includes four sets of items: 1) reasons for general treatment preference based on goals/outcomes and preference for LAI vs pills based on 2) personal experience, 3) injection-site (deltoid vs gluteal), 4) dosing frequency (3-monthly vs 1-monthly). A logistic regression analysis was performed to assess the effect of baseline variables on preference (LAIs or pills).

Results: Data from 1402 patients were available for analysis. Patients who preferred LAIs recognized these outcomes as important: "I feel more healthy" (57%), "I can get back to my favorite activities" (56%), "I don't have to think about taking my medicines" (54%). Most common reasons for medication preference (LAI vs pills) were: "LAIs/pills are easier for me" (67% vs 18%), "more in control/don't have to think about taking medicine" (64% vs 14%), "less pain/sudden symptoms" (38% vs 18%) and "less embarrassed" (0% vs 46%). Majority of patients (59%) preferred deltoid over gluteal injections (reasons: faster administration [63%], easier [51%], less embarrassing [44%]). In total, 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing citing reasons: fewer injections [96%], fewer injections are less painful [84%], and fewer doctor visits [80%]. From logistic regression analysis, 77% of patients preferred LAI over pills; culture and race appeared to play a role in this preference.

Conclusion: Patients who preferred LAI antipsychotics prioritized self-empowerment and quality-of-life-related goals. When given the option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.

Keywords: long-acting injectable antipsychotics; oral antipsychotics; paliperidone palmitate; patient preference; quality-of-life.

Conflict of interest statement

PS, IN, AK, AS, MM and SG are employees of Janssen Research & Development, LLC and hold company stocks. CB is a student at Pennsylvania State University and was working as a summer intern at Janssen Research & Development, LLC. The authors report no other conflicts of interest in this work.

© 2020 Blackwood et al.

Figures

Figure 1
Figure 1
Medication preference questionnaire.
Figure 2
Figure 2
Treatment goals/outcomes cited as important or not important for medication preference. Abbreviation: LAI, long-acting injectable.
Figure 3
Figure 3
Reasons for preference for LAI vs oral antipsychotics. Abbreviation: LAI, long-acting injectable.
Figure 4
Figure 4
Reasons for injection-site preference: deltoid vs gluteal.
Figure 5
Figure 5
Medication preference based on dosing frequency and reasons for preference. Abbreviation: LAI, long-acting injectable.

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