- Background: The pharmacological treatment landscape of schizophrenia in Germany is diverse, and comprehensive information about treatment patterns is limited. This study provides an overview of the demographics of patients with schizophrenia in Germany, alongside exploring treatment patterns of both oral antipsychotics (OAs) and long-acting injectable antipsychotics (LAIs), including discontinuation and adherence rates.
Methods: This cross-sectional, retrospective claims database study examined a prevalent schizophrenia population using the German InGef research database from January 2020 to December 2022. Adult patients with ≥1 inpatient and/or ≥2 outpatient ICD-10-GM schizophrenia diagnoses during the enrolment period (January–December 2021) and treatment with ≥1 antipsychotic in the 1-year post-index period were included. Daily estimated OA intake was calculated using the WHO Daily Defined Dose. The number of LAI injections was estimated using representative injection intervals asBackground: The pharmacological treatment landscape of schizophrenia in Germany is diverse, and comprehensive information about treatment patterns is limited. This study provides an overview of the demographics of patients with schizophrenia in Germany, alongside exploring treatment patterns of both oral antipsychotics (OAs) and long-acting injectable antipsychotics (LAIs), including discontinuation and adherence rates.
Methods: This cross-sectional, retrospective claims database study examined a prevalent schizophrenia population using the German InGef research database from January 2020 to December 2022. Adult patients with ≥1 inpatient and/or ≥2 outpatient ICD-10-GM schizophrenia diagnoses during the enrolment period (January–December 2021) and treatment with ≥1 antipsychotic in the 1-year post-index period were included. Daily estimated OA intake was calculated using the WHO Daily Defined Dose. The number of LAI injections was estimated using representative injection intervals as recommended in the package leaflets and clinical practice guidelines. Treatment discontinuation was defined as a gap of 60 days after the days of supply of the previous prescription of the initial agent without a refill. Adherence was calculated using the proportion of days covered, with high adherence defined as a score of ≥0.8.
Results: A total of 11,291 patients with schizophrenia were included. Among those meeting the inclusion criteria, 53.8% were male, and the average age was 52.1 (± 16.9) years. As a first observable prescription during the post-index period, 68.9% were prescribed 1 OA, 10.7% received 1 LAI and among those with combination therapy on the same day, 18.5% had ≥2 OAs, 0.05% had ≥2 LAIs and 1.87% had ≥1 OA and LAI.
The final cohort comprised 8238 patients who received 1 antipsychotic drug, defined as the index agent, that was also prescribed to ≥100 patients. Olanzapine, risperidone, quetiapine and aripiprazole were the most commonly prescribed OAs (17.7%, 16.8%, 15.2% and 11.6%, respectively), while paliperidone, aripiprazole, flupentixol and risperidone were the most commonly prescribed LAIs (5.7%, 2.3%, 2.1% and 1.8%, respectively).
Patients prescribed LAIs showed lower treatment discontinuation rates compared to those prescribed OAs (18–27% vs 26–75%). Patients prescribed LAIs remained on treatment for longer on average until discontinuation than patients receiving OAs (144–191 days vs 106–163 days). Among OAs, olanzapine (n=1457) and ziprasidone (n=100) had the lowest proportion of discontinuations (36% and 26%, respectively), with patients treated with olanzapine, ziprasidone and aripiprazole remaining on treatment the longest (163, 162 and 155 days, respectively). The proportions of treatment switches to different molecules for patients on OAs and LAIs were relatively comparable (5–32% and 6–14%, respectively). Overall, a greater proportion of patients prescribed LAIs demonstrated high adherence, compared to OAs (39–52% vs 0–46%). Among OAs, more patients prescribed ziprasidone and olanzapine demonstrated high adherence (46% and 33%, respectively) compared to other OAs.
Conclusions: In this dataset from Germany, LAIs are less commonly prescribed than OAs, despite demonstrating better adherence and discontinuation outcomes. These findings are consistent with previous literature [1]. However, within OAs, some molecules exhibit more favourable outcomes than others.…
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