h. lundbeck a/s schizophrenia treatment landscape study final country report – canada q1 2013...

H. LUNDBECK A/S

Schizophrenia Treatment Landscape Study

Final country report – Canada

Q1 2013(Fieldwork August – October 2012)

Prepared by:InforMed InsightTel: +44 1625 [email protected]

mailto:[email protected]

2

Overview of Schizophrenia Treatment Landscape Study

Methodology: retrospective real-world study where physicians retrieved existing patient medical records for 6 patients meeting the screening criteria and entered information into an online survey

Target physicians: Psychiatrists (and Nervenärzte in Germany)

Scope: 13 markets (5EU, Poland, Australia, Brazil, Canada, Nordics)

Sample: 964 physicians and 5469 patient records

Included an over-sample on patients receiving LAI medication

Business objective: To gain a real-world snapshot into the management of patients with schizophrenia through the collection and

analysis of customised patient report formsSpecific focus on patient receiving LAI medication

Country Physicians (n) PRFs (n) Representative sample PRFs (n)

LAI oversample PRFs (n)

Canada 62 346 231 115

3

Sample size: patients receiving oral vs. LAI

*The oversample was specifically on patients receiving LAI medication, however some patients were receiving concomitant oral therapy, as shown above

The ratio of oral:LAI anti-psychotic prescriptions in the representative sample is 7:1 for all countries and

8:1 for Canada

Country Representative sampleOral (n) – Atypicals

Oral (n) - Typicals

LAI (n) – Atypicals

LAI (n) - Typicals

Canada 200 (90%) 16 (7%) 15 (7%) 11 (5%)

Country LAI oversample*

Oral (n) – Atypicals

Oral (n) - Typicals

LAI (n) – Atypicals

LAI (n) - Typicals

Canada25 (22%) 1 (1%) 76 (66%) 39 (34%)

Note that patients can receive more than one drug, hence percentages add up to more than 100%

Representative sample:This excludes the additional LAI

patients (oversample) and will give a reflective view of the market

LAI oversample:We collected additional patient

record forms for patient receiving LAI medications to boost the

sample size for patients receiving LAIs and permit sub-group

analysis

4

Physician and patient screening criteria

• Patients selected at random from existing records based on first initial of last name

• Adult patient (at least 18 years old) currently diagnosed with schizophrenia

• Seen by physician within the last 24 months (from date of interview)

• Over-sample on patients receiving LAI anti-psychotics:

•Physicians who initiate LAIs profiled 4 patients of any type & 2 specifically receiving a LAI medication

•Physicians who do not initiate LAIs profiled 6 patients of any type

• Psychiatrists

• Actively managing and treating patients with schizophrenia

• Treating 10 or more schizophrenia patients per month

• Majority of physicians LAI initiators

• Qualified for 3-30 years

• Representative mix of practice settings and regions within each market

Schizophrenia patientsPhysicians

5

Prescription count data from this Treatment Landscape study has a reasonable correlation with IMS treatment days data

Base: current prescriptions (representative patients) (n=4645)

IMS data summary• Time period: YTD 2012• Data level: volume shares (treatment days), %

R² (R-squared) is a measure of how well the data from the survey fits with IMS prescribing data, where 0 = no fit

and 1 = a perfect fit

olanzapine risperidone clozapine quetiapine aripiprazole paliperidone amisulpride ziprasidone asenapine paliperidone palmitate haloperidol levomepromazine chlorpormazine zuclopenthixol fluphenazine flupentixol

6

Structure of questionnaire

Part A: Physician profiling • Screening questions & physician profiling

• Caseload• Setting

• Perception based questions• Physicians overall prescribing of antipsychotics• Unmet needs• Adherence• Insight (anosognosia)

B: Patient record form (Completed PRFs)• Patient demographics• Disease profiling• Hospitalisations• Treatment profiling• Adherence• Insight• Quality of life• If on LAI: LAI specific questions

These sections are sign-posted within the presentation with these labels:

Physician profiling / perception PRF

7

Key thoughts

SETTING Physicians in Canada predominantly work in hospital acute care and out-patient clinics, working

mainly with out-patients or a mix of in-patients and out-patients Almost two thirds of patients are perceived to be stable with residual symptoms, 16% of patients

are current acute

MARKET SHARE Risperidone (24%) and olanzapine (21%) are the most commonly prescribed oral anti-

psychotics, Risperdal Consta is the most commonly prescribed LAI treatment along with typical LAIs (4% and 5% respectively)

Prescribing of typicals was higher previously

SWITCHING 50% of treatment switches / discontinuations are due to poor efficacy / symptom control, and

45% due to poor tolerability (significantly higher for orals than LAIs) Main reason for prescribing LAI treatment is poor adherence with oral therapy, with 22% of

patients also being prescribed it as a more convenient dosing form

INSIGHT 48% of patients are fully aware of their condition, 38% moderately aware and 14% fully unaware.

Patients receiving LAI treatment are significantly less likely to be fully aware than those on orals Actual awareness levels are higher than physician’s initial estimates

8

Interactive Dashboard of all data will be provided

This report has selected key points of interest for presentation purposes, but please note that more results can be accessed via the Interactive Dashboard:

This will be provided in Excel format early in 2013

If you have any questions regarding the use of the dashboard, please contact Gitte Esmann (GIES) or the InforMed team ([email protected])



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Report contents

• Physician profiling• Based on physician’s perception: insight and adherence

Physician insights

• Patient and disease profiling• Patient journey• Patient analysis by level of adherence and insight

Patient insights (based on PRFs)

• Overall prescribing, reasons for prescribing and switching• Exploration around LAI anti-psychotics

Treatment landscape

10

Section summary

All physicians initiate (prescribe) LAI anti-psychotics Physicians predominantly work in hospital acute care and out-patient clinics, working

mainly with out-patients or a mix of in-patients and out-patients Presence of side effects and no insight into the disease are perceived to be the main

reason for non/partial adherence, over 50% of doctors also note drug/alcohol as a significant reason

Switching to LAI injection is the most common and successful step to improve partial/non-adherence

69% of physicians are familiar with the term anosognosia, the majority believe it means a lack of awareness/insight into the condition

In patients that are only moderately aware of their schizophrenia, most physicians feel there is room for improvement in their insight

When asked directly, a patient’s level of insight is said to impact on prescribing decisions, most physicians are more likely to prescribe an LAI to a patient with a low level of insight rather than one with high insight

Low level of insight is felt to be the main reason for low patient adherence to treatment; to address this most physicians say that they switch to LAI treatment

11

Psychiatrists have an average of 17 years experience. Schizophrenia patients represent 32% of their (monthly) caseload. 100% of physicians initiate LAI treatment

S2: How many years have you been practicing in your clinical specialty, after qualifying? S3: Thinking about an average month, approximately how many patients do you see in total? Of these, how many patients with schizophrenia do you personally treat or manage in a month? S5: Do you initiate LAI treatment for patients with schizophrenia?

Physician profiling

Monthly caseload (S3) n=62)

SZ patients represent 32% of a physician’s total caseload

Years qualified (S2) (n=62)

17 years in practice

LA

I in

itia

tor

No

n-L

AI i

nit

i...0%

100%

100%

0%

LAI initiation (S5) n=62)

Source: Physician profiling. Base: all (n=62)

12

Physicians predominantly work in hospital acute care and out-patient clinics, working mainly with out-patients or a mix of in-patients and out-patients

S7 Approximately what percentage of your time spent in direct patient care is in each of the following health care locations? A1 What percentage of your time is spent working with in-patients versus out-patients?

Physician profiling


%

24%

48%

27%

Mix

Mostly-out-pa-tients

Mostly in-pa-tients

HospitalAcute care 33%Chronic care 8%

Out-patient clinic 28%

Day HospitalIntermediary

2%

Supply: retail Pharmacy

Supply: Hospital Pharmacy

Supply: Hospital Pharmacy

GP clinic 1%

Psych clinic 22%

Supply: retail Pharmacy

13

Physician’s estimate that the most commonly prescribed orals treatment are quetiapine, olanzapine and risperidone. The most commonly prescribed LAI treatment is Risperdal Consta

A2 Thinking about the patients with schizophrenia that you see in a typical month, approximately what proportion would be prescribed each of the following treatments?

RISPERIDONE CONSTA

PALIPERIDONE PALMITATE

OTHER

10%

5%

3%


Oral treatments LAI anti-psychotics

Physician profiling

OLANZAPINE

RISPERIDONE

CLOZAPINE

QUETIAPINE (Seroquel)

ARIPIPRAZOLE (Abilify)

PALIPERIDONE (Invega)

ZIPRASIDONE (Zeldox)

ASENAPINE (Saphris)

Other

23

22

9

24

11

6

2

4

Note: this question can be compared to actual prescribing collected in the patient record forms (question B22, slide 54)


14

Main unmet treatment needs are control of negative symptoms and metabolic side effects. Patient adherence is also mentioned by just under half of physicians

A3; Thinking in general about current treatments for schizophrenia, which of these areas do you feel require most improvement? Please select up to 7 options

Physician profiling

Control of negative symptoms

Control of metabolic side effects (including weight gain)

Relapse prevention/maintaining treatment response

Cost/reimbursementLevel of functioning (e.g. in social situations, being able to live inde-

pendently)Control of extrapyramidal side effects (including tardive dyskinesia, but

excluding akathisia)Patient adherence

Early treatment response

Availability of atypical depots

Overall quality of life

Patient satisfaction with treatment

Control of sedation

Control of aggressive symptoms (e.g. hostility and agitation)

Control of akathisia

Control of positive symptoms

Control of prolactin-related side effects (including sexual dysfunction)

Transition from oral to depot medication

Requirement for blood monitoring and/or liver function/liver status

Frequency of dosing

Mode of administration

84%

76%

53%

52%

48%

44%

41%

39%

32%

31%

27%

25%

20%

20%

19%

13%

12%

9%

9%

3%


15

Presence of side effects and no insight into the disease are perceived to be the main reason for non/partial adherence, over 50% of doctors also note drug/alcohol as a significant reason

A6 What do you think are the main reasons for patient’s not adhering or only partially adhering to their treatment regimen?

Presence of side effects

Not aware of illness (no insight into disease)

Drug/alcohol abuse

Forgetting to take their medicationAware of illness/symptoms, but does not recognise the need for

treatmentBelief that they are cured (lack of

insight)Aware of illness/symptoms, but

unwilling to accept that they have schizophrenia

Concerns about potential side ef-fects

Other disease symptom(s) affecting ability to take medication (e.g.

delusions, hallucinations)Complicated medication regimens

Lack of family supportCognitive impairment (not related to their schizophrenia e.g. dementia,

learning disability)Cost of medication

Other, please specify

85%

76%

52%

48%

45%

39%

26%

26%

24%

21%

19%

11%

13%

0%


% of physicians

Physician profiling

16

Switching to LAI injection is the most common and successful step to improve partial/non-adherence

A7 Please indicate which of the following steps you commonly use to improve non-adherence / partial adherence in your practice, and how much impact these have on adherence

Switch to depot injection

Simplify medication routine

Re-engage caregiver/support network

Discuss reasons for non-adherence with patient

Switch to other oral antipsychotic with perceived improved effect

Switch to other oral antipsychotic with fewer side effects

Adjust the dose

Initiate/add cognitive behavioural therapy (CBT)

Other (n=14)

79%

65%

63%

58%

52%

52%

47%

26%

35%

15%

34%

34%

42%

44%

48%

50%

34%

24%

6%

3%

5%

3%

40%

41%

Use, with good impact Use, with limited/ no impact Do not personally use


% of physicians

Physician profiling

Patient education / family involvement (n=4)More out-patient visits / increase

monitoring / refer on (n=4)Psychoeducation / family therapy (n=3)

17

69% of physicians are familiar with the term anosognosia, of those, majority believe it means a lack of awareness/insight into the condition

A8 Are you familiar with the term ‘anosognosia’?

69% 26% 5%

Yes, to me this means…Yes, I have heard of it but not sure what it meansNo, not at all

% of physicians

Source: Physician profiling. Base: all (n=62); physicians who gave a definition of anosognosia (n=43)

Physician profiling

3%3%3%

92%

Yes, to me this means… (coded responses)

18

Anosognosia is percieved to be mean a patient’s inability to realise they are ill, and a lack of understanding of what their disease is

Source: Physician profiling. Base: physicians who gave a definition of anosognosia (n=43)

“Inability to realise they are ill”

(Psychiatrist, Canada)

“No awareness of their disease symptoms”

(Psychiatrist, Canada )

“Patient not aware of their condition” (Psychiatrist,

Canada)

“Lack of self-assessment of their

disease” (Psychiatrist, Canada)

“No insight into the disease”

(Psychiatrist, Canada)

Yes, to me this means… (verbatim responses)

A8: Are you familiar with the term ‘anosognosia’?

Physician profiling

19

Physicians perceive that three-quarters of patients are moderately/fully unaware of their schizophrenia, however physicians feel that insight can improve in most of these patients

Moderately aware Fully unaware

56%

29%37%

48%

5% 16%2%

6%

Yes, insight can improve

Yes, insight can improve, but only to some extent

No, insight cannot improve

Don’t know

A10 Approximately what proportion of your patients at the current moment fit into each of the following categories in relation to their awareness of their schizophrenia?A11 If a patient is moderately aware / fully unaware of their schizophrenia for a year or more, do you believe the patients’ insight into their disease can improve?

% o

f ph

ysic

ian

s


36% 39% 25%

Fully aware Moderately aware Fully unaware

Physician profiling

20

Majority of physicians’ treatment decisions are said to be affected by the patient’s insight level, LAI treatment being more likely to be prescribed in patients with a low level of insight than high insight

61%

37%

2%

No impact at all

Some impact

Major impact

2%

82%

16%

... either high or low insight –it does not have a big influ-ence on my decision to pre-scribe a depot medication

... a low level of insight

... a high level of insight

A13a How much impact does the patient’s level of insight into their schizophrenia have on your treatment decision, if any?

% of physicians

Source: Physician profiling. Base: left chart - all (n=62); right chart – physicians whose treatment decision is influenced by level of insight (n=61)

Physician profiling

A13b Are you more likely to prescribe a LAI medication to a patient with…

Note: this question can be compared to actual prescribing of LAIs in patients depending on level of insight collected in the

patient record forms (question B22, slide 51)

21

Non-adherence to treatment is perceived to be the main consequence of poor insight, lower level of functioning is a consequence for 50% of patients

A12 What do you think are the main consequences of a patient’s poor/low level of insight into their schizophrenia?

% of physicians

Source: Physician profiling. Base: all (n=62) Source: Physician profiling. Base: all whose treatment decision is influenced by level of insight (n=61)

Non-adherence to treatment

Lower level of functioning

Lower quality of life (QoL)

Worsening of symptoms

Creates mistrust between doctor-patient

Increased need for caregiver support

Increased workload for treatment team

Lower health-related quality of life (HRQoL)

Other

79%

50%

45%

39%

37%

23%

18%

6%

2%

Physician profiling

Engage in other medically risky behaviour (cannabis use)

22

Report contents


Physician insights




Treatment landscape

23

Understanding the data charts for Section B – patient record form data

All patients - rep sample (n=231)

All orals (n=237) All LAIs (n=142) aripiprazole (n=32)

16% 15% 15% 16%

63%68% 67% 69%

19% 16% 17% 16%

2% 1% 1% 0%

Acute Stable with residual symptoms Stable without residual symptoms Other

These data are based on all patients (PRFs) in the

representative sample (i.e. the depot over-sample has been removed). This gives you the

best indication of the total patient population

These sub-groups are based on all prescriptions of orals / LAIs / aripiprazole. These take all prescriptions from both the

representative sample and the oversample. Therefore a patient may be included in all sub-groups (if they are receiving both an

oral and LAI, for example)

NB – This is not actual data

24

Section summary

60% of the last consultations were scheduled or routine follow-ups with 56% of patients getting repeat prescriptions

Almost two thirds of patients are perceived to be stable with residual symptoms, 16% of patients are current acute

57% of patients had no relapses in the last year, 30% have 1 relapse and 13% have more than 2 relapses

Relationship with the physician is the best rated overall and socio-economic factors are the most negatively impacted by the condition

The condition is said to have a negative impact on all QoL aspects, most notably ADLs Less than 15% of currently stable patients are anticipated to become non-adherent in

the near future Patients experience more negative symptoms in general 48% of patients are fully aware of their condition, 38% moderately aware and 14% fully

unaware. Patients receiving LAI treatment are significantly less likely to be fully aware than those on orals

25

Patient profile: 65% of patients are male, around 20% are employed, around 50% have no recorded drug or alcohol use

Source: Patient record forms. Base: Total PRFs (n=346)

B1to B5: demographics

PRF

Employment status (paid vs. unpaid)

BMI

Family status (top 2)

35% female and 65% maleAverage age: 40

Age at diagnosis: 27

Mean BMI = 25.6 (overweight)

64% livingindependently/with family

17% receiving some form of care11% without fixed address

Drug/alcohol use

51% do not use at all29% mild use

11% moderate use6% severe

Demographics







Patients receiving orals Patients receiving LAIs





63% livingindependently/with family18% receiving some form

of care10% other

64% livingindependently/with family

15% receiving some form of care13% without fixed address

Total

12% in paid employment7% in unpaid employment



26

Scheduled or routine follow up is the main reason for most recent consultation, treatment repeat is the most common action taken by physicians

Source: Patient record forms. Base: Base: Total rep sample (n=231)

B6a: What was the main reason(s) for the patient’s most recent consultation?

Reason Action

ConsultationsOn average 8 consultations per year(orals 8 : LAIs 9)

Scheduled or routine follow up (60%)

Orals 60%: LAIs 63%Treatment repeat (56%)

Orals 57%: LAIs 57%

Treatment stop (1%)Orals 0%: LAIs 0%

Treatment initiation (8%)Orals 7%: LAIs 4%

Treatment restart (7%)Orals 8%: LAIs 11%

Treatment change (24%)Orals 25%: LAIs 27%

Side effects(4%)

Orals 4%: LAIs 4%

Referral (6%)

Orals 5%: LAIs 7%

Diagnosis(10%)

Orals 9%: LAIs 6%

Acute episode /relapse (24%)

Orals 25%: LAIs 23%

Most frequent

Least frequent

PRF

B6b: What action was taken regarding the patient’s schizophrenia treatment?

27



16% 15% 15% 16%

63%68% 67% 69%

19%16% 17% 16%

2% 1% 1% 0%

Acute Stable with residual symptoms Stable without residual symptoms Other

Almost two thirds of patients are perceived to be stable with residual symptoms, 16% of patients are currently acute

Source: Patient record forms. Base: Total rep sample (n=231). aripiprazole prescriptions (n=32)

% o

f pa

tient

s

Status X

B12a/b: Current statusPlease indicate the current status of the patient’s schizophrenia using the following options:

PRF

28

Patients’ schizophrenia severity drops by 1.2 (on a 7-point rating scale) between first consultation and current level

Source: Patient record forms. Base: Total rep sample (n=231) aripiprazole prescriptions (n=32)

PRF

At first consultation Current severity

4.6

3.4

4.6

3.4

4.7

3.6

4.7

3.4

All patients - rep sample (n=231) All orals (n=237) All LAIs (n=142) aripiprazole (n=32)

B11: How would you rate the severity of the patient’s schizophrenia? Please answer on a scale of 1-7.

Mea

n s

co

re

Extremely mentally ill (7)

Normal, not at all mentally

ill (1)

29

57% of patients had no relapses in the last year, 30% have 1 relapse and 13% have more than 2 relapses




57% 56%50%

66%

30% 30% 39%

28%

13% 14% 11% 7%

2 - 5 relapses

1 relapse

0 relapses

B8b: How many psychotic relapses has the patient experienced in the past 12 months?

% o

f pa

tient

s

Mean relapses

PRF

0.6 0.6 0.6 0.4

30

Relationship with the physician is the best rated overall and socio-economic factors are the most negatively impacted by the condition


PRF

4.03.7

3.5

2.8

3.6

3.1

4.03.8

3.5

2.9

3.7

3.1

3.83.7

3.3

2.7

3.5

2.9

4.2

3.8 3.7

2.8

3.6

2.8

All patients - rep sample (n=231) All orals (n=237) All LAIs (n=142) aripiprazole (n=32)

B16a Patient circumstances: Please rate the patient’s situation in relation to the following attributes:

Mea

n s

co

re

Very high/ very good (5)

Very low/ very bad (1)

31

The condition is said to have a negative impact on all QoL aspects, most notably ADLs


B14 Quality of life: How much impact does the patient’s schizophrenia have on the patient’s…?

PRF

Overall quality of life Activities of daily living (e.g. household chores,

shopping)

Social relationships Ability to work

3.9

3.4

3.84.03.9

3.4

3.84.03.9

3.53.7

4.23.9

3.43.6

3.9

All patients - rep sample (n=231) All orals (n=237)All LAIs (n=142) aripiprazole (n=32)

Mea

n s

co

re

Profound Impact (5)

No impact (1)

32

Less than 15% of currently stable patients are anticipated to become non-adherent in the near future

Source: Patient record forms. Base: Total rep sample (n=189)

B34 : You described the patient as currently “stable with/without residual symptoms”. Despite the patient being stable, do you anticipate him/her to become non-adherent within the near future?

Total rep sample (n=

189)

Atypical orals (n=190)

Typical orals (n=12)

Aripiprazole (n=26)

Atypical LAIs (n=72)

Typical LAIs (n=47)

79% 77%83%

77% 79% 74%

6% 6% 4% 4%4%

8% 10% 15% 11%13%

7% 6%17%

4% 6% 9%

Don’t know

Yes, I anticipate the patient to become non-adherent within the next 6 months

Yes, I anticipate the patient to become non-adherent within the next 3 months

No, I don’t have any reason to anticipate non-adherence in the near future

PRF

% o

f pa

tient

s

33

Total rep sample (n=231)



aripiprazole (n=32)


Typical LAIs (n=51)

67% 68%

76%

63%

75% 73%76% 78%

59%

78%74%

76%

53%56%

35%

47%

60%

53%

Positive symptoms (hallucinations, delusions, thought disorder, changes in behaviour, disorganised speech)Negative symptoms (lack of interest, social withdrawal, emotional flatness, inability to concentrate)Other symptoms (suicidal thoughts, aggression, irritability, sexual dysfunction, cognitive deficits, anosognosia)

Patients experience more negative symptoms in general

Source: Patient record forms. Base: Total rep sample (n=231), oral prescriptions (n=237), aripiprazole prescriptions (n=32), LAI prescriptions (n=142)

B29: Current symptomsPlease indicate which symptoms the patient currently experiences as part of their schizophrenia

1.5 1.7 1.5 1.7 1.5 1.5 1.2 1.7 1.8 1.7 1.4 1.6

PRF

Mean no. of symptoms

% o

f pa

tient

s

34

48% of patients are fully aware of their condition, 38% moderately aware and 14% fully unaware. Patients receiving LAI treatment are significantly less likely to be fully aware than those on orals


B15: Is your patient aware that he/she has schizophrenia?

Total (rep sample) (n=231)


48% 50%

36%

53%

38% 38%

41%

38%

14% 13%23%

9%

Fully unaware

Moderately aware

Fully aware

Mean score 2.3 2.4 2.1 2.4

% o

f pa

tient

s

PRF

Note: this question can be compared to A10 in

the physician perception section

35

Report contents


Physician insights




Treatment landscape

36







37

Section summary

Hospital psychiatrists are responsible for 50% of atypical treatment, current physicians are responsible for over 50% of typical oral treatment, GPs have some (minimal) involvement, especially for LAI patients

50% of patients are managed in out-patient clinics, this is significantly higher for patients on atypical LAIs compared to atypical orals

Over 80% of patients are currently managed by the respondent physician. GPs and psychiatric nurses also have some involvement in current patient management (19% and 11% respectively)

The average period between symptoms and consultations is 101 weeks, consultation and diagnosis 68 weeks, diagnosis and treatment 53 weeks

36% of patients have been hospitalised within the last year, 18% have never been hospitalised. Patients on aripiprazole are significantly less likely to have hospitalised than those on all atypical orals

Majority of patients were switched from one antipsychotic treatment to another when hospitalised. 24% of patients were discharged on LAI formulations

38

First saw

Diagnosed

Initiated tx

First saw

Diagnosed

Initiated tx

18%

24%

23%

12%

18%

22%

7%

10%

6%

6%

55%

57%

59%

61%

61%

57%

8%

7%

10%

8%

6%

Yourself GP Other Psychiatrist, Hospital Other Psychiatrist, Office

First saw

Diagnosed

Initiated tx

First saw

Diagnosed

Initiated tx

25%

33%

33%

59%

53%

53%

10% 46%

50%

48%

29%

35%

35%

11%

9%

9%

Hospital psychiatrists are responsible for 50% of atypical treatment, current physicians are responsible for over 50% of typical oral treatment, GPs have some (minimal) involvement, especially for LAI patients

Source: Patient record forms. Base: Patients receiving orals (n=237); Patients receiving LAI (n=142)

Patients receiving orals Patients receiving LAIs

B10b: And which of the following healthcare professional(s) are/were responsible for each of the following?

First saw / Diagnosed / Initiated treatment

Atypical

Typical

Atypical

Typical

PRF

“Yourself” indicates that management is by the person completing the survey. Refer to slide 12 for physician's setting

39

B10a: Please indicate which of the following settings the patient is currently managed in?

Total rep sample (n=231)



Aripiprazole (n=32)


Typical LAIs (n=51)

50% 41%55%

41%59% 67%

29%32%

35%

31%

29%

14% 23%8%

13%

29%

5%

6% 5%14%

9%

18%

21%

8% 8%

10%

6%

6%

9%9%

8%

Outpatient clinic Psychiatric clinic Hospital, acute care Hospital (chronic/long-term care)GP clinic/ PCP clinic Other, please specify

% o

f pa

tient

s

50% of patients are managed in out-patient clinics, this is significantly higher for patients on atypical LAIs compared to atypical orals


PRF

Note: this question can be compared to physician

practice setting (slide 12)

40

B10b: Please indicate which of the following Healthcare professionals are responsible for current management of the patients

% o

f pa

tient

s




aripiprazole (n=32)


Typical LAIs (n=51)

84% 85% 88% 81% 86% 88%

19% 20%6%

6%

19% 14%

7% 7%18%

13%

13%5% 6%

6%8%

11% 12%18%

9%

16%16%

5%6% 12%

6%

8% Don’t know / not applicable

Other

Paediatrician / adolescent specialist

Psychiatric nurse

Geriatrician

Clinical psychologist

Neurologist

Other psychiatrist, office

Other psychiatrist, hospital

GP_Primary Care Physician

Yourself

Over 80% of patients are currently managed by the respondent physician. GPs and psychiatric nurses also have some involvement in current patient management (19% and 11% respectively)

PRF


“Yourself” indicates that management is by the person completing the survey. Refer to slide 13 for physician's setting

41

The average period between symptoms and consultations is 101 weeks, consultation and diagnosis 68 weeks, diagnosis and treatment 53 weeks


oral treatments (n=173) aripiprazole (n=26) LAI treatments (n=97)

101 99

72

97

68 66

20

5253 51

10

53

Symptoms --> consultation First consultation --> diagnosis Diagnosis --> treatment

Source: Patient record forms. Base: rep sample (n=170) Patients receiving orals (n=173); Patients receiving LAIs LAIs (n=97); aripiprazole prescriptions (n=26)

Tim

e (

we

eks

)

B9: Thinking about the patient’s schizophrenia, what was the time period between…

… first experiencing symptoms and first consultation (with yourself or another physician)?

… first consultation and receiving diagnosis?

… diagnosis and initiation of treatment?

B7b: How long has the patient been in your care?

3.5 years in current psychiatrists’ care(3.7 oral: 3.6 LAI)

PRF

Base: all patients with stated timeframes, note actual sample size varies slightly for each part of the question, sample shown is maximum

42

36% of patients have been hospitalised within the last year, 18% have never been hospitalised. Patients on aripiprazole are significantly less likely to have hospitalised than those on all atypical orals

Source: Patient record forms. Base: all (n=346); Orals (n=237) versus aripiprazole (n=32) versus LAIs (n=142)

Yellow box - patient record forms for those who have been hospitalised in the last 12 months/duration (n=128/72)

B17: Has the patient ever been hospitalised for their schizophrenia?

% o

f pa

tient

s

14% 14%24%

16% 15% 18%

22% 20%

24%

16%

36%18%

44% 48%

41%

41%

42%

45%

18% 17%12%

28%

5%

14%

6%

Don't know

No

Yes, more than 12 months ago

Yes, within the last 12 months

Yes, currently hospi-talised

B18: How many times has the patient been hospitalised for their schizophrenia in the last 12 months?2 times hospitalised in the last 12 months

Mean number of hospitalisations in last year

1.2 2.3 1.3 4.5 5.3 1.2

PRF

B19: What was the duration of the most recent schizophrenia-related hospital stay?Duration: 3.7 weeks

When hospitalised:

43

Majority of patients were switched from one antipsychotic treatment to another when hospitalised. 24% of patients were discharged on LAI formulations

Source: Patient record forms. Base: Representative sample. Patients who received an antipsychotic treatment change at discharge from hospital (n=25)

B21a: How was the patient’s antipsychotic treatment changed during his/her stay in hospital?

PRF

B21b: Was the patient discharged on a LAI formulation?

Antipsychotic treatment prescribed for the first time ever

Switch from one antipsychotic to another

Switch to an antipsychotic from another therapeutic category

Switch from an antipsychotic from another therapeutic category

Add-on of an antipsychotic to regimen

Antipsychotic treatment stopped, with no other therapies initiated

Change in dosing of existing antipsychotic

Change in formulation of existing antipsychotic

Other

Don’t know

4%

60%

4%

16%

4%

12%

% of patients

Series1

24%

76%Don't know

No

Yes

Source: Patient record forms. Base: Representative sample. Patients who have previously been hospitalised (n=50)

44

Report contents


Physician insights




Treatment landscape

45

Less adherent patients are less likely to be employed or living alone, and are more likely to be drug/alcohol users than fully adherent patients

Source: Patient record forms. Base: Fully adherent (n=260), partially (n=78), not at all adherent (n=19)


PRF


BMI

Family status (top 2)




25% living alone / independently

4% living with partner and children

28% Living with parents

Drug/alcohol use

57% none30% mild use


Demographics






26% living with parents




15% living alone / Independently



21% none5% mild use




Partially adherent – 22% Not at all adherent – 5%Fully adherent - 73%




46

Less adherent patients have more relapses, higher severity and rate of hospitalisation, and a low level of insight than fully adherent patients


B1to B5: disease profile

PRF

Age at diagnosis: 27Years in current psychiatrists

care: 3.8

Normal / borderline ill: 31%Moderate: 62%Severely ill: 7%

Fully aware 52% Moderately aware 35%

Fully unaware 13%

Normal / borderline ill: 13%Moderate: 76%

Severely ill: 12%


Severely ill: 16%

Number of relapses: 0.5

Fully aware 26% Moderately aware: 55%

Fully unaware 19%

Fully aware 32% Moderately aware: 26%

Fully unaware 42%


care: 2.9


care: 2.3

Number of relapses: 0.9 Number of relapses: 1.3

Ever hospitalised: 79%Never hospitalised: 18%



Current severity

Relapses in the last year

Insight

Timeframes

Hospitalisations

Partially adherent – 22% Not at all adherent – 5%Fully adherent - 73%

47

42%

21%

58%

5%

26%

14%

81%

9%

6%


Typical LAIs (n=10)


aripiprazole (n=)

Typical orals (n=6)

27%

17%

65%

10%

5%

Patients with lower levels of adherence are more likely to be prescribed LAIs and less likely to receive atypical orals


B22 Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?

Mean # treatments = 1.2% on more than 1 treatment = 18%

Mean # = 1.4% on more than 1 = 33%


PRF

Partially adherent – 22% Not at all adherent – 5%Fully adherent – 73%

Note: data taken from total sample (not representative sample). Therefore figures are not indicative of market share

48

Fully unaware patients are less likely to be employed and more likely to be drug/alcohol users than fully aware patients

Source: Patient record forms. Base: Fully aware (n=156), moderately (n=133), fully unaware (n=59)


PRF


BMI

Family status(top 2)







Drug/alcohol use



Demographics

















Moderately aware – 38% Fully unaware – 17% (low insight)

Fully aware – 45%(high insight)




49

Fully unaware patients have spent less time in the current psychiatrist’s care, had more relapses in the last year, are more severe and have lower adherence than fully aware patients


B1to B5: disease profile

PRF


care: 4.7


Full adherent: 84% Partially adherent: 12%

Non-adherent: 4%



Severely ill: 39%

Number of relapses: 0.3

Full adherent: 65% Partially adherent: 31

Non-adherent: 5%

Full adherent: 60% Partially adherent: 26%

Non-adherent: 14%


care: 3.0


care: 2.0

Number of relapses: 0.8 Number of relapses: 1.0




Current severity

Adherence

Timeframes

Hospitalisations

Relapses in the last year


Fully aware – 45%(high insight)

50

45%

17%

55%

5%

2%

28%

16%

63%

9%

8%

Patients with lower level of insight are more likely to receive atypical LAIs and less likely to receive atypical orals


Atypical LAIs (n=)

Typical LAIs (n=)

Atypical orals (n=)

Aripiprazole (n=)

Typical orals (n=)

19%

13%

74%

11%

4%

B22: Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?

Mean # treatments = 1.2% on more than 1 treatment = 16%

Mean # = 1.2 % on more than 1 = 19%


PRF


Fully aware – 45% (high insight)

Note: data taken from total sample (not representative sample). Therefore figures are not indicative of market share

51

Report contents


Physician insights




Treatment landscape

52







53

Section summary Most commonly prescribed orals are risperidone and olanzapine, Risperdal Consta is the

most commonly prescribed LAI treatment. Risperidone is the most common previously oral treatment, typical LAIs are the most common previously used LAI anti-psychotics

Average patient age is 40 years. Patients receiving aripiprazole are significantly younger than patients receiving other oral treatments

Overall, positive symptoms are the most common reasons for prescribing anti-psychotic treatment, also general attributes are significantly more important reasons for the LAI anti-psychotics. Specifically, treating delusions is the most common reason for prescribing a drug, with positive impact on QoL rated second (although this comes is primary reason for prescribing aripiprazole)• LAIs more likely to be prescribed for anticipated patient adherence than orals• Aripiprazole is more likely to be prescribed for anticipated positive impact on QoL and overall

functioning than other orals Main reason for prescribing LAI treatment is poor adherence with oral therapy, with 22% of

patients also being prescribed it as a more convenient dosing form. Satisfactory adherence with or response to oral therapy are the most common reasons for not prescribing an LAI treatment

50% of treatment switches / discontinuations are due to poor efficacy / symptom control, and 45% due to poor tolerability (significantly higher for orals than LAIs)

Weight gain and sedation are the most common side effects (both significantly more likely with oral treatments), 31% of patients overall experienced no side effects (higher for aripiprazole patients)

54

Current prescribing: Risperidone and olanzapine are the most commonly prescribed oral anti-psychotics, Risperdal Consta is the most commonly prescribed LAI anti-psychotic along with typical LAIs

Source: Patient record form. Base: All patients – rep sample (n=231)

B22: Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?

OLANZAPINE

RISPERIDONE

CLOZAPINE

QUETIAPINE

ARIPIPRAZOLE

PALIPERIDONE

AMISULPRIDE

ZIPRASIDONE

ASENAPINE

OTHER ATYPICAL

TYPICALS

21%

24%

12%

17%

13%

5%

7%

RISPERIDONE CONSTA


OTHER ATYPICAL

TYPICALS

4%

2%

5%


PRF

Note: this question can be compared to physician’s estimated prescribing

(question A2, slide 13)


55

RISPERIDONE CONSTA


OTHER ATYPICAL

TYPICALS

3%

0%

10%

OLANZAPINE

RISPERIDONE

CLOZAPINE

QUETIAPINE

ARIPIPRAZOLE

PALIPERIDONE

AMISULPRIDE

ZIPRASIDONE

ASENAPINE

OTHER ATYPICAL

TYPICALS

23%

26%

3%

11%

4%

3%

19%

Previous prescribing: Was higher for the typicals (especially orals). Risperidone oral is also a common previous treatment

Source: Patient record form. Base: All patients – rep sample (n=231)

B35 Previous treatments Which antipsychotic treatment(s) were prescribed as part of the patient’s previous treatment regimen?

PRF


30% have not received any

previous treatment


56

Average patient age is 40 years. Patients receiving aripiprazole are significantly younger than patients receiving other oral treatments

Source: Patient record form. Base: total rep sample (n=231)

Total (rep sample) - (n=231)


40 41 41

34

B1: Please provide the patient’s year of birth (note, the patient must be 18 years of age or over):

B22: Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?

PRF

Me

an

ag

e (

yea

rs)

57

The majority of prescriptions are repeats

Source: Patient record form, prescription level.

Base: oral prescriptions (n=237), LAI prescriptions (n=142).

risperidone consta (n=9)

paliperidone palmitate

(n=5)

olanzapine (n=49)

risperidone (n=55)

clozapine (n=27)

quetiapine (n=40)

aripiprazole (n=29)

paliperidone (n=8)

11%

80%

22%35%

15%

45% 41%

13%

33%20%

7%

7%

10%7%

44%

20%

51% 51%

59%

30% 41%

63%

11% 5%

7%10%

7%25%

7%

Don't know

Other

Switch

Repeat

Restart (have used the drug within the past 6 months)

Start (i.e. newly prescribed, not used the drug previously)

% o

f al

l pre

scrip

tions

B24 Current treatment details. Treatment status - start, repeat, switch, re-start?

PRF

CAUTION: Low bases (n<30)

58

Detailed analysis of treatments: LAIs

LAIs Mean dose (mg)Current & previous

Mean duration of prescribing

Previous/ current

FormulationCurrent & previous

Mean satisfaction(1=very poor, 5 =

very good)Current & previous

Mean adherence(1=fully adherent, 3=non-adherent)

Current & previous

Risperdal Consta 47.5 mg 44.3 / 106 weeks 100% IM depot injection

3.8 / 3.1 1.4 / 1.5

paliperidone palmitate

130 mg 45 / 34 weeks 100% IM depot injection

4.0 / 1.0 1.1 / 1.0

B24 & B36 Drug grids (full text in notes)

PRF

Source: Patient record form, prescription level.

Base: oral prescriptions (n=237), LAI prescriptions (n=142).

59

87%

51%

52%

48%

60%

66%

To treat - positive symptoms

To treat - negative symptoms

To treat - other symptoms

Side-effect profile

General attributes

Patient level attributes

87%

54%

52%

51%

59%

67%

Positive symptoms are the most common reasons for prescribing anti-psychotic treatment, also general attributes are significantly more important reasons for the LAI anti-psychotics

82%

41%

48%

32%

70%

61%

Source: Patient record form, prescription level. Base: all rep sample (n=261) oral prescriptions (n=303), LAI prescriptions (n=185)

B33 Why did you prescribe (drug X) to the patient? Category totals


PRF

All treatments - rep sample

Anticipated positive impact on overall quality of lifeAnticipated positive impact on overall functioning (cognitive and social)

• Orals rated higher for treatment of negative symptoms and side-effect profile than LAI anti-psychotics

60

Treating delusions is the most common reason for prescribing a drug, with positive impact on QoL rated second (although this comes is primary reason for prescribing aripiprazole)

Source: Patient record form, prescription level. Base: all rep sample (n=261) oral prescriptions (n=303), LAI prescriptions (n=185)

Total (rep sample) - (n=261) All orals (n=303) All LAIs (n=185) aripiprazole (n=42)

74% 75%

67%

74%

61% 60%

55%

81%

58% 58% 57%55%

51% 52%

48%

74%

47% 46%

39% 40%40%38%

29%

52%

37% 38%

31%

38%36% 36%

48%50%

32% 33% 35%31%30%

28%

20%

29%

Delusions Anticipated positive impact on overall quality of life HallucinationsAnticipated positive impact on overall functioning (cognitive and social) Thought disorder Social withdrawalChanges in behaviour Anticipated (improved) patient adherence IrritabilityInability to concentrate

B33 Why did you prescribe (drug X) to the patient?

PRF

• Orals rated higher for social withdrawal and ability to concentrate than LAI anti-psychotics • LAIs rated higher for anticipated patient adherence• Aripiprazole rated higher for anticipated positive impact on QoL and overall functioning than other

orals

61

B26 Why was the patient prescribed a LAI formulation treatment?

All LAI (n=142) Atypical LAIs (n=91) risperidone consta (n=61)

paliperidone palmitate (n=26)

Typical LAIs (n=51)

78% 77% 82%62%

80%

24% 27% 23%42%

18%

10% 12% 8% 19%14%

18% 15%

27%

8%

11%14%

5%

35%

6%

4%7%

5%

8%

0%

22%

25%

26%

27%

16%

Poor adherence with oral therapy Poor treatment response / residual symptoms Patient request

Family request Side effects/tolerability of previous treatment Anticipated side effects/tolerability of prescribed treatment

More convenient dosing form Other, please specify Don’t know

% o

f pa

tient

s

PRF

Main reasons for prescribing LAI treatment is due to poor adherence with oral therapy, with 22% of patients also being prescribed it as a more convenient dosing form

Source: Patient record forms, prescription level. Base: LAI prescriptions (n=142)

62

Delusions and anticipated positive impact on patient quality of life are consistently the most common reasons for prescribing

Orals Top 3 reasons for prescribing

All orals (n=304)

Delusions– 75%, Anticipated positive impact on QoL – 60%, Hallucinations–

58%

All Atypical orals (n=290)

Delusions– 76%, Anticipated positive impact on QoL – 61%, Hallucinations–

59%

risperidone (n=77)Delusions – 88%, Hallucinations – 76%,

Anticipated positive impact on QoL– 66%

paliperidone (n=10)Delusions– 80%, Social withdrawal –

50%, Emotional flatness – 50%

olanzapine (n=81)Delusions– 2%, Hallucinations – 54%,

Anticipated positve impact on QoL– 51%

aripiprazole (n=42)

Anticipated positive impact on QoL – 81%, Anticipated positive impact on functioning– 74%, Delusions – 74%

All typicals (n=28)

Delusions – 57%, Anticipated positive impact on QoL – 50%, Hallucinations –

46%

LAIs Top 3 reasons for prescribing

All LAI (n=185)

Delusions– 67%, Hallucinations – 57%, Anticipated positive impact on QoL –

55%


Delusions– 66%, Hallucinations– 60%, Anticipated positive impact on QoL –

58%

Risperdal Consta (n=76)

Delusions – 61%, Hallucinations– 55%, Anticipated (improved) patient adherence

– 53%


Delusions – 76%, Hallucinations– 70%, Anticipated positive impact on QoL /

Anticipated positive impact on functioning– 67%

olanzapine pamoate (n=0)

Typical LAIs (n=28)Delusions– 69%, hallucinations – 52%,

Anticipated positive impact on QoL– 51%

Source: Patient record forms, prescription level. Base: previous treatments that were switched due to poor efficacy / symptom control

B33 Why did you prescribe (drug X) to the patient?

CAUTION: Low bases (<n=30)

63

B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?


48% 51% 46% 47%

45% 47%35%

58%

25% 22%

15%

47%11% 13%

14%

33%

8%8%

17%

3%

9%

11%

21%

Poor efficacy/symptom control Poor tolerability/complaints about side effect(s) Cost/reimbursementPatient request Family request Availability of a new treatment optionFormulary restrictions Inconvenience / not easy to use Mode of administration (i.e. change to different formulation)Other, please specify

% o

f tr

eat

men

ts

PRF

50% of treatment switches / discontinuations are due to poor efficacy / symptom control, and 45% due to poor tolerability (significantly higher for orals than LAIs)

Source: Patient record forms, prescription level. Base: total rep sample (n=195)

• Poor tolerability is less of a reason for switch from LAIs than orals• Switching due to patient request and availability of a new treatment option is more

significant for aripiprazole than other orals

64

Poor efficacy and poor tolerability are consistently the most common reasons for treatment switch, patient request is a common reason for oral switch, mode of administration is a common reason for LAI switch

LAIs Top 3 reasons for switching

All LAI (n=163)

Poor efficacy / symptom control– 46%, Poor tolerability / side effects – 35%,

Mode of administration – 21%


Poor efficacy / symptom control– 45%, Rpoor tolerability / side effects – 32%,

Mode of administration– 20%


Poor efficacy / symptom control – 36%, Poor tolerability / side effects– 28%,

Mode of administration – 27%


Poor efficacy / symptom control– 64%, Poor tolerability / side effects– 38%,

Availability of new treatment option– 26%


Typical LAIs (n=55)

Poor efficacy / symptom control– 47%, poor tolerability / side effects – 40%,

Mode of administration– 22%

B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?

Source: Patient record forms, prescription level. Base: total rep sample (n=195)

Orals Top 3 reasons for switching

All orals (n=197)

Poor efficacy / symptom control– 51%, Poor tolerability / side effects – 47%,

Patinet request– 22%


Poor efficacy / symptom control– 49%, Poor tolerability / side effects– 48%,

Patient request– 22%

risperidone (n=25)

Poor tolerability / side effects –56%, Poor efficacy / symptom control– 36%,

Patient request– 16%

*paliperidone (n=9)

Poor tolerabilty / side effects– 44%, Poor efficacy / symptom control– 22%, Patient

request– 22%

olanzapine (n=42)

Poor efficacy / symptom control – 48%, Poor tolerability / side effects – 45%,

patient request– 19%

aripiprazole (n=36)

Poor tolerability / side effects– 58%, poor efficacy / symptom control– 47%,

patient request– 47%

All typicals (n=15)

Poor efficacy / symptom control– 67%, poor tolerability / side effects – 33%,

Patient request – 27%

65

Delusions and hallucinations are consistently perceived as uncontrolled symptoms, social withdrawal and thought disorder are also highlighted as common uncontrolled symptoms

LAIs Top 3 uncontrolled symptoms

All LAI (n=75)Delusions– 81%, Hallucinations – 69%,

Thought disorder – 59%

Atypical LAIs (n=49)Delusions– 82%, hallucinations – 73%,

Thought disorder– 63%

Risperdal Consta (n=24)Delusions– 75%, Hallucinations – 71%,


paliperidone palmitate (n=25)Delusions– 88%, hallucinations – 76%,

Social withdrawal– 60%


Typical LAIs (n=26)Delusions– 81%, Hallucinations – 62%,

Irritability– 50%

B37b Which symptom(s) was [drug X] poor in controlling? – symptoms

Source: Patient record forms, prescription level. Base: previous treatments that were switched due to poor efficacy / symptom control

Orals Top 3 uncontrolled symptoms

All orals (n=100)Delusions– 79%, Hallucinations – 66%,


All Atypical orals (n=90)Delusions– 78%, Hallucinations – 63%,


risperidone (n=9)Delusions – 100%, Hallucinations– 67%,


*paliperidone (n=2)Social withdrawal– 100%, Hallucinations

– 100%,

olanzapine (n= 20)

Delusions – 75%, hallucinations– 55%, Social withdrawal / Emotional flatness –

50%

aripiprazole (n=17)Hallucinations – 82%, Delusions – 65%,

Social withdrawal – 53%

All typicals (n=10)Hallucinations – 90%, Delusions– 90%,


66

Weight gain and sedation are the most common side effects (both significantly more likely with oral treatments), 31% of patients overall experienced no side effects (higher for aripiprazole patients)

Source: Patient record form, prescription level. Base: total rep sample (n= 261) oral prescriptions (n=305), LAI prescriptions (n=185)

B23: Please indicate which side effects the patient has experienced as a result of taking [drug X], if any?


31% 30%

40%

45%

16% 14%

5%7%

38%36%

22%20%

11%12%

20%

5%6%

8%

12%

18%

7% 7%

10%

2%

33%31%

22%

18%

3% 3% 2%5%

No side effects Metabolic side effects (excluding weight gain)

Weight gain Extrapyramidal side effects (including tardive dyskinesia) (not including akathisia)

Akathisia Prolactin-related side effects (including sexual dysfunction)

Sedation Injection site reactions

Other, please specify Don’t know

% o

f pr

escr

iptio

ns

PRF

• Metabolic side effects, weight gain and sedation are higher for orals than LAIs

• EPS are higher for LAIs than orals• Injection site reactions are higher for aripiprazole

than other orals• Weight gain higher for orals versus aripiprazole

67

Weight gain and sedition are consistently rated as the most common side effects,18% of patients receiving aripiprazole highlight akathisia as a side effect

LAIs Top 3 side effects % No side effects

All LAI (n=185)

Weight gain– 22%, Sedation– 22%,

Extrapyramidial side effects – 20%

40%



Extrapyramidal side effects / Prolactin related

side effects– 12%

41%



Extrapyramidal side effects– 18%

32%


Sedation – 22%, Weight gain – 14%,

56%


Typical LAIs (n=67)

Extrapyramidal side effects– 34%, Akathisia –

24%, Sedation – 16%

39%

B23: Please indicate which side effects the patient has experienced as a result of taking [drug X], if any?

Orals Top 3 side effects

% No side effects

All orals (n=305)

Weight gain– 36%, Sedation– 31%, Metabolic

side effects – 14%

31%


Weight gain – 38%, Sedation – 33%,

Metabolic side effects – 15%

30%

risperidone (n=77)


extrapyramidal side effects – 18%

30%

*paliperidone (n=10)

Weight gain – 30%, Extrapyramidal side

effects– 20%, Prolactin related side effects – 20%

50%

olanzapine (n=81)

Weight gain– 49%, Weight gain– 25%,

Metabolic side effects – 19%

28%

aripiprazole (n=44)

Weight gain– 20%, Akathisia– 18%, Sedation

– 18%

45%

All typicals (n=28)

Extrapyramidal side effects– 32%, Sedation – 29%, Weight gain– 18%

36%

Source: Patient record form, prescription level. Base: oral prescriptions (n=305), LAI prescriptions (n=185)

68

Report contents


Physician insights




Treatment landscape

69

All LAIs (n=142) Atypical LAIs (n=91) Risperidone Consta (n=61)

Paliperidone palmitate (n=26)

Typical LAIs (n=51)

35%

48%

69%

12%

30%

20%

15%

35%

47%

20%22%

7%

58% 16%

5%5% 5%11%4% 5% 4%

22%

Don’t know No previous treatment Another LAIs treatment Oral formulation of a different drug

Oral formulation of the same drug

% o

f pa

tient

s

B25 What treatment was the patient (currently on LAI), receiving before their LAI medication?

PRF

In patients on LAIs, 35% of patients were previously receiving an oral formulation of the same drug, 30% an oral formulation of a different drug, 20% another LAI treatment

Source: Patient record forms. Base: patients currently receiving LAI (n=142)

Risperidone (n=6)Olanzapine (n=3)

70

Satisfactory adherence with oral therapy

Satisfactory treatment response to oral therapy

Patient unwillingness

I never offered a depot formulation to the patient

The right drug is not available as a depot formulation

Patient's current condition/symptoms (e.g. delusions, lack of insight into disease or need for treatment)

Family unwillingness

Other, please specify

Practical reason e.g. not being able to attend hospital for injection

Cost/reimbursement

Formulary restrictions

Low experience / familiarity with depot treatment

I am unsure how to approach injections with the patient (e.g. because I don’t want to damage the doctor-patient relationship)

Don’t know

52%

43%

25%

25%

9%

6%

5%

4%

3%

3%

2%

1%

0%

0%

% o

f pa

tient

s

B28 Why is the patient not currently on a LAI formulation treatment?

PRF

Satisfactory adherence with or response to oral therapy are the most common reasons for not prescribing an LAI treatment

Source: Patient record forms. Base: patients not currently receiving LAI (n=197)

71

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h. lundbeck a/s schizophrenia treatment landscape study final country report – canada q1 2013...

Documents

additional lai patients

lai medication physicians

type patients

lai medications

management of patients

market lai oversample

lai antipsychotics

patient records