Monthly paliperidone improves outcomes for Blacks with criminal justice involvement

Abstract

Monthly paliperidone improves outcomes for Blacks with criminal justice involvement African Americans with schizophrenia are overrepresented in the criminal justice system compared with other ethnic groups with schizophrenia, leading to concerns over the adequacy of care for this population. The potential for nonadherence to oral medication for schizophrenia increases the risk of repeat hospitalizations and incarceration. The long-acting injectable (LAI) antipsychotic paliperidone palmitate offers a potential alternative to reduce the risk of relapse. A post hoc subgroup analysis of the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study compared the efficacy and safety of LAI paliperidone and oral antipsychotics in delaying the time to first treatment failure in African Americans with schizophrenia and criminal justice involvement. African American adults aged 18 to 65 with a DSM-IV diagnosis of schizophrenia and at least two contacts with the criminal justice system over the previous 2 years (with at least one of the contacts resulting in incarceration) were eligible for the analysis. Among those excluded were individuals with an opioid use disorder. Among the conditions that were considered a treatment failure in the 15-month study were arrest/ incarceration, psychiatric hospitalization, discontinuation of antipsychotic medication for reasons such as safety or inadequate efficacy, and suicide. The prevalence of treatment failures due to any event was 35.9% in the LAI paliperidone group and 52.3% in the group receiving an oral antipsychotic. Median time to first treatment failure was not reached in the LAI paliperidone group and was 270 days in the oral antipsychotic group. Psychiatric hospitalization and arrest/incarceration were the most common reasons for first treatment failure. The mean cumulative number of treatment failures over 15 months was lower in the LAI paliperidone group. Treatment discontinuations due to adverse events occurred in 11% of LAI paliperidone patients and 5.4% of oral antipsychotic patients, with insomnia, akathisia, and weight gain more common in the LAI group. These results were generally in line with the overall PRIDE findings and suggest a benefit for the long-acting injectable formulation in African American patients with complex conditions. [Lynum K, et al. J Clin Psychiatry 2021; published online Feb 23; doi: 10.4088/JCP.20m13356]