Abstract
Background
There is limited information on patient’s perspective on choice of long-acting injectable (LAIs) or oral antipsychotic pills used in the management of schizophrenia. Assessing factors that determine patients’ preferences for LAI or oral antipsychotics could help understand their expectations from the treatment and 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 to patients on day 1 (baseline; open-label stabilization phase), were used. The questionnaire includes 4 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 (4) dosing frequency. A logistic regression analysis was performed to assess the effect of baseline variables on preference for LAIs or pills.
Results
Patients who preferred LAIs identified 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%]). 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing (reasons: fewer injections [96%], fewer injections are less painful [84%], fewer doctor visits [80%]). In the logistic regression analysis (n=1402), 77% of patients preferred LAI over pills and culture and race appeared to play a role in this preference.
Discussion
Patient empowerment and quality-of-life-related goals were important for patients who preferred LAI antipsychotics and when given an option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.