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H. LUNDBECK A/S
Schizophrenia Treatment
Landscape Study
Final country report - UK
January 2013
(Fieldwork August – October 2012)
Prepared by:
InforMed Insight
Tel: +44 1625 509280
[email protected]
Overview of Schizophrenia Treatment Landscape
Study
Business objective: To gain a real-world snapshot into the
management of patients with schizophrenia through the collection and
analysis of customised patient report forms
Specific focus on patient receiving LAI medication
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 Nervenärztes in Germany)
Scope: 13 markets (5EU, Poland, Australia, Brazil, Canada, Nordics)
Total sample: 964 physicians and 5469 patient records
Included an over-sample on patients receiving LAI medication
Country Physicians (n)
UK
104
PRFs (n)
Representative
sample PRFs (n)
LAI oversample PRFs
(n)
613
411
202
2
2
Sample size: patients receiving
oral vs. LAI
Representative sample:
Country
This excludes the additional LAI
patients (oversample) and will give
a reflective view of the market
UK
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
Representative sample
Oral (n) –
Atypicals
Oral (n) Typicals
LAI (n) –
Atypicals
LAI (n) Typicals
348 (87%)
26 (7%)
27 (7%)
22 (6%)
Country
UK
The ratio of oral:LAI antipsychotic prescriptions in
the representative sample
is 7:1 for all countries and
19:1 for UK
LAI oversample*
Oral (n) –
Atypicals
Oral (n) - Typicals
19 (9%)
10 (5%)
LAI (n) – Atypicals LAI (n) - Typicals
113 (56%)
90 (45%)
Note that patients can receive more than one drug, hence percentages add up to more than 100%
*The oversample was specifically on patients receiving LAI medication, however some patients were receiving concomitant oral therapy, as shown above
3
Physician and patient screening criteria
Physicians
• Psychiatrists (and Nervenärztes in
Germany)
• Actively managing and treating patients
with schizophrenia (decision maker)
• 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 patients
• 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
treatments:
• 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
4
Prescription counts in the treatment landscape study are an effective
predictor of IMS values; the data generally correlates well with IMS
values
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 = perfect correlation
The regression coefficient is a measure
of effectiveness of B22 in ‘predicting’ the
value of the IMS data: in most EU
countries, B22 tends to slightly
underestimate IMS values (coefficient > 1)
IMS data summary:
•
•
•
•
Time period: MAT Q2 2012
Data level: sum of Rx (000s) (absolute)
ICD-10 indication(s): F20 Schizophrenia
Locales: retail only
olanzapine
risperidone
paliperidone palmitate
Base: current prescriptions (representative patients) (n=4645)
clozapine
quetiapine
aripiprazole
paliperidone
5
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)
Part 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
6
Key thoughts - UK
SETTING


Around half of the physicians’ time is spent in a community care setting and half in a hospital
setting
Over half of all patients are stable with residual symptoms, but this reduces to just over 40% for
patients on aripiprazole; around half of all patients have not had a relapse in the last 12 months
MARKET SHARE

In the UK, 91% of patients diagnosed with schizophrenia receive an oral therapy. Prescribing of
aripiprazole is similar to the Global picture. All UK psychiatrists can initiate LAI medications; 12%
of patients receive an LAI. Monotherapy is higher than other markets; only 9% of patients receive
more than 1 treatment
SWITCHING


The main reason for switching away from previous treatment is poor tolerability and side effects,
particularly for aripiprazole. Mode of administration is a key driver for LAIs
Low adherence to oral therapy is a major reason why physicians will switch to an LAI
INSIGHT


A patient’s level of insight has a major impact on prescribing in over three-quarters of physicians,
and the vast majority of physicians feel that they are more likely to prescribe an LAI to a patient
with a low level of insight
Around half of patients are moderately aware of their condition. Patients on LAI treatments have
lower level of awareness than patients receiving oral treatments. Level of insight is similar to
physicians’ estimates (slightly fewer are fully unaware than estimated)
7
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
(ObservationalStudySZ@in
formed-insight.com)
8
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
9
Section summary






Three quarters of physicians have been practising for over 10 years and
nearly half of their caseload is schizophrenia patients
The majority of physicians’ time is spent working in Community Care (PCT)
or hospital setting (mainly acute)
Side effects are the major reasons why patients do not, or only partially
adhere to their treatment, but a low level of insight into their disease is also a
major driver for non-adherence
The most common step taken to improve patient adherence is switching to
LAI treatment, as this is perceived to be most effective by 80% of physicians
Almost 60% of physicians felt they understood the term anosognosia, of
whom the majority gave an accurate description. However 43% were not
sure what this term means (high relative to other markets)
A patient’s level of insight has a major impact on prescribing in over threequarters of physicians, and the vast majority of physicians feel that they are
more likely to prescribe an LAI to a patient with a low level of insight
10
Physician profiling
Physicians have been practising for 17 years on average. Just under
half of their patients are schizophrenia patients. All physicians initiate
LAI treatment in patients with schizophrenia
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?
Years qualified (S2) (n = 104)
LAI treatment initiation (S5)
100%
0%
% of physicians
100%
16.9 years in practice
Source: Physician profiling. Base: all (n=104)
Non-LAI
initiator
LAI initiator
0%
SZ patients represent 46% of a
physician’s total caseload
11
Physician profiling
Physician profiling – the majority of physicians’ time is spent working
in Community Care (PCT) or hospital setting (mainly acute), and
around half of their time is spent with mostly 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?
Supply: Hospital
Pharmacy
Relapse
Private
practice 2%
Day Hospital
Intermediary 2%
26%
Supply: Hospital
Pharmacy
Community
care (PCT)
47%
Supply: retail
Pharmacy
% of physicians
Hospital
Acute care 32%
Chronic care 8%
Mixed
Mostly-outpatients
52%
Supply: retail
Pharmacy
Mostly inpatients
Relapse
Private
Hospital 1%
%
22%
Supply: Retail
Pharmacy
Source: Physician profiling. Base: all (n=104)
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Physician profiling
Physician’s estimate that olanzapine, risperidone, and quetiapine
are the most widely prescribed orals, and Risperdal Consta is the
most widely prescribed LAI
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?
Oral treatments
23%
OLANZAPINE
RISPERIDONE
CLOZAPINE
ARIPIPRAZOLE
ASENAPINE
OTHER ATYPICAL
RISPERIDONE
CONSTA
20%
PALIPERIDONE
PALMITATE
41%
12%
12%
OLANZAPINE
PAMOATE
2%
AMISULPRIDE
ZIPRASIDONE
20%
11%
QUETIAPINE
PALIPERIDONE
LAI treatments
3%
5%
0%
OTHER
ATYPICAL
1%
1%
2%
Note that patients can receive more than one drug, hence percentages add up to more than 100%
Source: Physician profiling. Base: all (n=104)
Note: this question can
be compared to actual
prescribing collected in
the patient record forms
(question B22, slide 54)
13
Physician profiling
Control of metabolic side effects and negative symptoms are the two
main unmet needs as perceived by UK 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
Control of metabolic side effects (including weight gain)
75%
Control of negative symptoms
73%
Relapse prevention/maintaining treatment response
54%
Patient adherence
53%
Level of functioning (e.g. in social situations, being able to live…
44%
Overall quality of life
43%
Control of positive symptoms
40%
Patient satisfaction with treatment
40%
Control of extrapyramidal side effects (including tardive dyskinesia,…
39%
Early treatment response
36%
Control of prolactin-related side effects (including sexual dysfunction)
30%
Availability of atypical depots
29%
Control of akathisia
21%
Control of sedation
19%
Control of aggressive symptoms (e.g. hostility and agitation)
18%
Cost/reimbursement
13%
Mode of administration
13%
Requirement for blood monitoring and/or liver function/liver status
12%
Frequency of dosing
Transition from oral to depot medication
Source: Physician profiling. Base: all (n=104)
8%
3%
14
Physician profiling
Low patient adherence is perceived to be due primarily to the
presence of side effects, but lack of awareness of the disease
(insight) is also a major factor
A6 What do you think are the main reasons for patient’s not adhering or only partially adhering to their treatment regimen?
87%
Presence of side effects
Not aware of illness (no insight
into disease)
Aware of illness/symptoms, but
does not recognise the need…
Belief that they are cured (lack of
insight)
Forgetting to take their
medication
Concerns about potential side
effects
79%
55%
51%
49%
40%
30%
Drug/alcohol abuse
Aware of illness/symptoms, but
unwilling to accept that they…
Complicated medication
regimens
Other disease symptom(s)
affecting ability to take…
29%
20%
16%
15%
Lack of family support
Cognitive impairment (not related
to their schizophrenia e.g.…
Cost of medication
Other, please specify
12%
0%
1%
Sells the drugs
% of physicians
Source: Physician profiling. Base: all (n=104)
15
Physician profiling
The most common and effective step taken to improve patient
adherence is perceived to be switching to LAI treatment
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
Use, with good impact
Use, with limited/ no impact
Switch to LAI injection
80%
Switch to other oral antipsychotic with fewer side effects
Switch to other oral antipsychotic with perceived improved effect
12%
2%
58%
54%
26%
0%
57%
38%
1%
4%
55%
41%
1%
1%
45%
45%
Adjust the dose
Source: Physician profiling. Base: all (n=104)
45%
51%
Discuss reasons for non-adherence with patient
Other (n=17)
42%
54%
Re-engage caregiver/support network
Ask patient to record drug taking
Discuss risks of non-compliance
Psychotherapy
Dosette box / blister pack
19%
57%
Simplify
medication routine
Initiate/add cognitive behavioural therapy (CBT)
Do not personally use
19%
35%
56%
% of physicians
16
Physician profiling
Almost 60% of physicians felt they understood the term
anosognosia, of whom the majority gave an accurate description.
However 43% were not sure what this term means
A8 Are you familiar with the term ‘anosognosia’?
% of physicians
Yes, to me this means…
58%
36%
7%
Yes, I have heard of it but not sure
what it means
No, not at all
Yes, to me this means… (coded responses)
81%
10%
Lack of awareness
of/insight into
condition/disability
Denial of illness
5%
5%
3%
Unable to recognise
faces
Unable to recognise
objects
Lack of awareness of
part of body
Source: Physician profiling. Base: all (n=104); physicians who gave a definition of anosognosia (n=60)
17
Physician profiling
Perceived knowledge of poor insight
A8: Are you familiar with the term ‘anosognosia’?
Yes, to me this means… (verbatim responses)
“Denial that one is
suffering from a
disorder”
(Psychiatrist, UK)
“An impaired
awareness of illness”
(Psychiatrist, UK)
“Inability to recognise the
fact of having an illness/
impairment”
(Psychiatrist, UK)
“Unawareness of
ones disease”
(Psychiatrist, UK)
“Lack of awareness
about illness”
(Psychiatrist, UK)
Source: Physician profiling. Base: physicians who gave a definition of anosognosia (n=60)
18
Physician profiling
Physicians estimate that over 60% of patients are moderately aware,
or fully unaware of their disease. Physicians believe that insight in the
majority of these patients can be improved
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?
Fully aware
Moderately aware
39%
24%
% of physicians
37%
Fully unaware
Yes, insight can improve
65%
Yes, insight can improve, but
only to some extent
No, insight cannot improve
55%
36%
34%
1%
Moderately aware
Source: Physician profiling. Base: all (n=104)
9%
Fully unaware
19
Physician profiling
Over three-quarters of physicians state that a patient’s level of
insight has a major impact on prescribing. 85% of these are more
likely to prescribe an LAI to a patient with a low level of insight
A13a How much impact does the patient’s level of
insight into their schizophrenia have on your treatment
decision, if any?
A13b Are you more likely to prescribe
a LAI medication to a patient with…
... a high level of insight
77%
Major impact
... a low level of insight
22%
1%
85%
Some impact
No impact at all
% of physicians
13%
... either high or low insight –
it does not have a big
influence on my decision to
prescribe a depot
medication
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)
Source: Physician profiling. Base: left chart - all (n=104); right chart – physicians whose treatment decision is influenced by level of insight (n=103)
20
Physician profiling
Majority of physicians consider non-adherence to treatment to be the
main consequence of patients’ poor insight
A12 What do you think are the main consequences of a patient’s poor/low level of insight into their schizophrenia?
82%
Non-adherence to treatment
45%
Worsening of symptoms
Lower level of functioning
37%
Creates mistrust between doctor-patient, making it more
difficult to engage the patient in treatment
37%
34%
Increased workload for treatment team
32%
Lower quality of life (QoL)
16%
Increased need for caregiver support
10%
Lower health-related quality of life (HRQoL)
Other
1%
Increases the chance of admission to hospital
% of physicians
Source: Physician profiling. Base: all whose treatment decision is influenced by level of insight (n=104)
21
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
22
Understanding the data charts for Section B –
patient record form data
NB – This is not actual data
Acute
Stable with residual symptoms
68%
63%
16%
19%
15%
2%
Stable without residual symptoms
69%
67%
16%
15%
1%
17%
16%
1%
All patients - rep sample Patients receiving orals Patients receiving LAIs
(n=3759)
(n=3887)
(n=3887)2
This data is based on all patients
(PRFs) in the representative
sample (i.e. the depot oversample has been removed). This
gives you the best indication of
the total patient population
Other
16%
0%
Patients receiving
aripiprazole (n=632)
These sub-groups are based on all patients receiving orals /
LAIs / aripiprazole. These take all patients 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)
23
Section summary





Over half of all patients are stable with residual symptoms, but this reduces
to just over 40% for patients on aripiprazole. Slightly more patients on
aripiprazole are acute
Around half of patients on all treatment options have not had a relapse in the
last 12 months. Patients on aripiprazole have fared slightly better with nearly
60% having no relapse (although this is not statistically significant).
Furthermore these patients have significantly higher levels of support from
HCPs than patients on orals. They also score significantly better in terms of
activities of daily living
Only around 20% of patients are expected to become non-adherent within
the next 3-6 months
Around half of patients are moderately aware of their condition
Patients on LAI treatments have lower level of awareness than patients
receiving oral treatments. Level of insight is similar to physicians’ estimates
(slightly fewer are fully unaware than estimated)
24
PRF
Patient profile: male bias in the sample. Almost two-thirds of
patients not in employment – higher in patients receiving LAIs
B1to B5: demographics
All patients
Oral prescriptions
(total sample)
37% female and 63% male
Average age: 40
Age at diagnosis: 28
40% female and 60% male
Average age: 39
Age at diagnosis: 28
Mean BMI = 24.94
(normal)
Mean BMI = 24.81
(normal)
LAI prescriptions
34% female and 66% male
Average age: 41
Age at diagnosis: 28
Demographics
Mean BMI = 25.32
(normal)
BMI
Employment status
(paid vs. unpaid)
Family status
(top 2)
Drug/alcohol use
9%: in paid employment
12% in unpaid
employment
9%: in paid employment
12% in unpaid
employment
42% living alone /
independently
7% living with partner
and children
39% living alone /
independently
7% living with partner
and children
25% mild use
22% moderate use
7% severe
25% mild use
21% moderate use
6% severe
Source: Patient record forms. Base: all (n=613)
7%: in paid employment
10% in unpaid
employment
45% living alone /
Independently
6% living with partner
and children
23% mild use
24% moderate use
10% severe
25
PRF
Over half of the most recent consultations were scheduled or routine
follow-ups. Over half of patients had their treatment repeated
B6a: What was the main reason(s) for the patient’s most recent consultation?
B6b: What action was taken regarding the patient’s schizophrenia treatment?
B8a: How many times have you seen the patient for their schizophrenia in the last 12 months?
Most
frequent
Least
frequent
Scheduled or routine follow up (55%)
Treatment repeat (54%)
Orals 54%: LAIs 57%
Orals 54%: LAIs 61%
Acute episode /relapse (30%)
Treatment change (19%)
Orals 32%: LAIs 31%
Orals 22%: LAIs 23%
Diagnosis (7%)
Treatment initiation (11%)
Orals 6%: LAIs 3%
Orals 10%: LAIs 4%
Side effects(7%)
Treatment restart (11%)
Orals 6%: LAIs 4%
Orals 11%: LAIs 9%
Referral (5%)
Stop treatment (0%)
Orals 4%: LAIs 3%
Orals 0%: LAIs 0%
Reason
Action
Source: Patient record forms. Base: All patients – rep sample (n=411)
26
PRF
Over half of all patients are stable with residual symptoms, but this
reduces to just over 40% for patients on aripiprazole (not statistically
significant)
B12a/b: Current status
Please indicate the current status of the patient’s schizophrenia using the following options:
Acute
Stable with residual symptoms
55%
Stable without residual symptoms
Other
54%
53%
% of patients
42%
31%
22%
24%
22%
1%
All patients - rep sample
(n=411)
25%
24%
22%
20%
1%
All orals (n=394)
2%
All LAIs (n=250)
Source: Patient record forms. Base: All patients – rep sample (n=411). aripiprazole prescriptions (n=59)
2%
aripiprazole (n=59)
27
PRF
The overall severity of the disease has improved for all patients since
their first consultation, with no differences between the treatment options
B11: How would you rate the severity of the patient’s schizophrenia? Please answer on a scale of 1-7.
4.3
4.3
4.4
4.2
Mean score
Extremely
mentally ill
(7)
3.2
3.2
3.2
3.2
All patients - rep sample (n=411)
All orals (n=394)
All LAIs (n=250)
aripiprazole (n=59)
Normal, not
at all
mentally ill
(1)
At first consultation
Current severity
Source: Patient record forms. All patients – rep sample (n=411). aripiprazole prescriptions (n=59)
28
PRF
Around half of patients have not had a relapse in the last 12
months. Patients on aripiprazole have fared slightly better with
nearly 60% having no relapse (not statistically significant)
B8b: How many psychotic relapses has the patient experienced in the past 12 months?
0.7
0.7
0.8
0.6
13%
14%
15%
15%
37%
37%
36%
28%
% of patients
Mean # relapses
6 to 10
2 to 5
1
0
50%
49%
48%
All patients - rep sample
(n=411)
All orals (n=394)
All LAIs (n=250)
Source: Patient record forms. All patients – rep sample (n=411). aripiprazole prescriptions (n=59)
57%
aripiprazole (n=59)
29
PRF
Patients are perceived to have a fairly good relationship with physicians and support
from HCPs. Patients on LAIs score significantly lower than those on orals for all
attributes. Patients on aripiprazole have significantly higher levels of support from HCPs
than patients on orals
B16a Patient circumstances: Please rate the patient’s situation in relation to the following attributes:
• LAIs scored significantly higher than orals on all attributes at the 5% level
• Support from HCPs is significantly higher for aripiprazole (4.0) than orals (3.8) at the 5% level
Very high /
very good
(5)
4.0
3.8 3.8
3.5
4.0
3.7 3.8 3.6
3.4 3.5
3.1
Mean score
3.8
3.7 3.6
3.5
3.7
3.2
3.0 3.0
3.4
3.3 3.3
3.0
2.8
Very low /
very
poor(1)
Relationship with
physician
Support from
HCPs
All patients - rep sample (n=411)
Support from
family / friends
Socio-economic Current treatment Previous treatment
factors (e.g.
response
response
financial situation)
All orals (n=394)
All LAIs (n=250)
Source: Patient record forms. Base: total (n=411) versus aripiprazole prescriptions (n=59)
aripiprazole (n=59)
30
PRF
On average, a patient’s schizophrenia is perceived to have some
impact on all quality of life measures. Patients on aripiprazole fare
better on activities of daily living than patients on orals
B14 Quality of life: How much impact does the patient’s schizophrenia have on the patient’s…?
• A patient’s schizophrenia has significantly more impact on activities of daily living if they
are on orals vs. on aripiprazole, at the 5% level
Profound
impact (5)
3.6 3.6 3.7
3.3
3.3 3.3 3.3
3.6 3.6 3.7 3.5
3.7 3.7 3.8 3.6
Social relationships
Ability to work
Mean score
3.0
No impact
(1)
Overall quality of life
Activities of daily living
(e.g. household chores,
shopping)
All patients - rep sample (n=411)
All orals (n=394)
All LAIs (n=250)
Source: Patient record forms. Base: total (n=411) versus aripiprazole prescriptions (n=59)
aripiprazole (n=59)
31
PRF
Only ~20% of patients are expected to become nonadherent within the next 3-6 months
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?
10%
5%
9%
11%
11%
10%
10%
21%
21%
18%
13%
12%
13%
11%
Don’t know
7%
8%
7%
Yes, I anticipate the patient to
become non-adherent within the next
6 months
14%
68%
70%
65%
69%
73%
No, I don’t have any reason to
anticipate non-adherence in the near
future
43%
Total patients Atypical orals
(rep sample)
(n=275)
(n=317)
Typical orals
(n=28)
Yes, I anticipate the patient to
become non-adherent within the next
3 months
aripiprazole
(n=40)
Atypical LAIs
(n=112)
Typical LAIs
(n=83)
Source: Patient record forms. Base: all patients that are currently stable with/without residual symptoms (n=317)
32
PRF
Positive and negative symptoms are more commonly experienced than ‘other’
symptoms. >80% of patients on typical orals experience positive symptoms.
More patients on aripiprazole experience negative vs. positive symptoms
B29: Current symptoms
Please indicate which symptoms the patient currently experiences as part of their schizophrenia
Positive symptoms
Mean no. of
symptoms
1.4 1.2
1.6
1.3
Negative symptoms
1.8 1.3
1.2
1.2
Other symptoms
2.0
1.3
1.7 1.2
83%
72%
68%
68% 67%
% of patients
64%
67%
68%
74%
71%
69%
63% 63%
61%
55%
49%
Total (rep sample)
(n=411)
51%
48%
Atypical orals
(n=368)
Typical orals
(n=36)
aripiprazole (n=59)
Source: Patient record forms. Base: total (n=411) versus aripiprazole prescriptions (n=59)
Atypical LAIs
(n=141)
Typical LAIs
(n=112)
33
PRF
Only 15% of patients are reported to be fully unaware of their condition. Patients on LAIs
have significantly lower levels of awareness than patients on orals. Level of insight is
similar to physicians’ estimates (slightly fewer are fully unaware than estimated)
B15: Is your patient aware that he/she has schizophrenia?
Note: this can be compared to the
physician perception question (A10)
• Patients on LAI treatments have significantly lower levels of awareness than patients on oral treatments, at the 1% level
Mean score
2.2
2.2
2.1
15%
15%
20%
2.5
12%
% of patients
Fully unaware
47%
51%
46%
Moderately aware
51%
Fully aware
38%
38%
Total (rep sample) n=411
All orals (n=394)
29%
All LAIs (n=250)
37%
aripiprazole (n=59)
Source: Patient record forms. Base: total (n=411) versus aripiprazole prescriptions (n=59)
34
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
35
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
(ObservationalStudySZ@in
formed-insight.com)
36
Section summary






Hospital psychiatrists tend to be the key HCPs for the consultation,
diagnosis, treatment and the management of the patients across all
treatment options
Psychiatric nurses are not involved at all in the UK (less than 1%)
Duration between symptoms and consultation tends to be much longer than
time between first consultation and diagnosis, and diagnosis to treatment (89
weeks vs. 52 weeks vs. 46 weeks)
Around 1/3 of patients have been hospitalised within the last 12 months.
Patients have been hospitalised significantly more on atypical LAIs, although
approximately half of the hospitalisations were >12 months ago
The largest proportion of patients currently hospitalised are those on typical
orals – this is significantly more than those on aripiprazole or LAIs
During hospital stays, over half of patients are switched from one
antipsychotic to another. 20% of patients were discharged on an LAI
(compared to 12% overall level of LAI prescribing)
37
PRF
Hospital psychiatrists tend to be responsible for seeing the patients
first, diagnosis and treatment initiation. Similar for orals and LAIs
B10b: And which of the following healthcare professional(s) are/were responsible for each of the following?
First saw / Diagnosed / Initiated treatment
Oral prescriptions
LAI prescriptions
Atypical
Atypical
First saw
18%
Diagnosed
26%
Initiated tx
27%
15%
37%
0%
50%
0%
First saw
20%
17%
51%
15%
Diagnosed
Initiated tx
10%
Diagnosed
19% 1%
Initiated tx
26%
46%
57%
0%
17%
11%
53%
11%
Typical
Typical
First saw
16%
8%
14%
25%
22%
44%
0%
0%
Yourself
First saw 6% 14%
25%
56%
58%
GP
17%
Diagnosed
12%0%
17%
Initiated tx
13%0%
Other Psychiatrist, Hospital
41%
55%
59%
26%
21%
17%
Other Psychiatrist, Office
“Yourself” indicates that management is by the person
completing the survey. Refer to slide 12 for physician's setting
Source: Patient record forms. Base: oral prescriptions (n=394); LAI prescriptions (n=250)
38
PRF
Overall, patients tend to be managed in acute hospital setting or outpatient clinic. Fewer patients on atypical LAIs are managed in an outpatient clinic compared to atypical orals
B10a: Please indicate which of the following settings the patient is currently managed in?
Note: this question can be
compared to physician
practice setting (slide 12)
% of patients
• Significantly fewer patients on atypical LAIs are managed in an out-patient clinic compared
to atypical orals, at the 1% level
9%
10%
3%
2% 2%
2%
40%
8%
6%
3%
41%
41%
14%
3%
2%
14%
2%
44%
3%
29%
17%
Don't know / not
applicable
1%
5%
Other, please specify
37%
Judicial/forensic setting
(prison)
Out-patient clinic (CMP)
42%
42%
Total (rep
Atypical orals
sample) (n=411)
(n=368)
36%
37%
Typical orals
(n=36)
aripiprazole
(n=59)
Source: Patient record forms. Base: all rep sample (n=411)
43%
Atypical LAIs
(n=141)
Hospital, acute care
37%
Typical LAIs
(n=112)
39
PRF
One third to a half of patients tend to be managed by hospital
psychiatrists. Psychiatric nurses are not involved at all in the UK
(less than 1%)
B10b: Please indicate which of the following Healthcare professionals are responsible for current management of the patients
Yourself
Other psychiatrist, hospital
Neurologist
Geriatrician
Paediatrician / adolescent specialist
Don’t know / not applicable
% of patients
19%
36%
GP_Primary Care Physician
Other psychiatrist, office
Clinical psychologist
Psychiatric nurse
Other
20%
25%
37%
17%
19%
32%
44%
16%
15%
26%
46%
41%
17%
10%
14%
18%
18%
8%
Total (rep sample)
(n=411)
Atypical orals
(n=368)
Typical orals
(n=36)
14%
17%
16%
6%
aripiprazole (n=59)
Atypical LAIs
(n=141)
Typical LAIs
(n=112)
“Yourself” indicates that management is by the person
completing the survey. Refer to slide 12 for physician's setting
Source: Patient record forms. Base: all rep sample (n=411)
40
PRF
Duration between symptoms and consultation is much longer than time from
first consultation to diagnosis, and diagnosis to treatment (89 wks vs. 52 wks
vs. 46 wks)
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?
94
89
85
Time (weeks)
74
52
46
49
46
39
43
13
6
Total (rep sample)
Oral treatments
aripiprazole (n=59)
LAI treatments
(n=411)
(n=394)
(n=250)
Symptoms --> consultation
First consultation --> diagnosis
Diagnosis --> treatment
Source: Patient record forms. Base: all rep sample (n=411)
Base: all patients with stated timeframes, note actual sample size varies slightly for each part of the question, sample shown is maximum
41
PRF
Around 1/3 of patients have been hospitalised within the last 12 months. Patients have
been hospitalised significantly more on atypical LAIs than atypical orals, although
approx. half of the hospitalisations were >12 months ago. Significantly more patients
on typical orals are currently hospitalised than on aripiprazole and LAIs
B17: Has the patient ever been hospitalised for their schizophrenia?
B18: How many times has the patient been hospitalised for their schizophrenia in the last 12 months?
B19: What was the duration of the most recent schizophrenia-related hospital stay?
Mean number of
hospitalisations
in last year
1.4
1.4
1.5
1.3
1.3
1.5
4%
4%
3%
3%
4%
9%
2%
9%
21%
20%
% of patients
14%
22%
47%
36%
40%
Don't know
55%
41%
44%
No
11%
17%
Yes, more than 12 months ago
23%
17%
14%
18%
17%
17%
14%
19%
Total (rep
sample)
(n=411)
Atypical
orals
(n=368)
Atypical
LAIs
(n=141)
Typical LAIs
(n=112)
Typical aripiprazole
orals (n=36) (n=59)
Yes, within the last 12 months
Yes, currently hospitalised
36%
18%
When hospitalised:
• Significantly more atypical LAI patients have
been hospitalised than atypical orals, at the 5%
level
• Significantly more patients on typical orals are
currently hospitalised than on aripiprazole and
LAIs, at the 1% level
Source: Patient record forms. Base: all (n=411); yellow box - patient record forms for those who have been hospitalised (n=306)
Orals (n=394) versus aripiprazole (n=59) versus LAIs (n=250)
42
PRF
Over half of patients were switched from one antipsychotic treatment to
another during a hospital stay. 20% of patients were discharged on an LAI
(compared to 12% overall level of LAI prescribing)
B21a How was the patient’s antipsychotic treatment changed during
his/her stay in hospital?
B21b: Was the patient discharged on a
LAI formulation?
% of patients
Antipsychotic treatment prescribed for the first time
ever
22%
59%
Switch from one antipsychotic to another
Switch from an antipsychotic toanother 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
5%
0%
2%
% of patients
Switch to an antipsychotic from another theraputic
category
Don't know
80%
No
Yes
0%
7%
2%
20%
Other
Don’t know
2%
0%
Source: Patient record forms. Base: Representative sample. Patients who
received an antipsychotic treatment change at discharge from hospital
(n=41)
Source: Patient record forms. Base: Representative sample.
Patients who are currently hospitalised / have been hospitalised in
last 12 months (n=71)
43
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
44
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
(ObservationalStudySZ@in
formed-insight.com)
45
PRF
Patients who have lower level of adherence are more likely to be
female and be currently in employment. They also seem to have
lower use of drugs / alcohol
B1to B5: demographics
Fully adherent
Partially adherent
Not at all adherent
37% female and 62% male
Average age: 40
Age at diagnosis: 28
36% female and 64% male
Average age: 41
Age at diagnosis: 28
53% female and 47% male
Average age: 34
Age at diagnosis: 28
Mean BMI = 25.0
(overweight)
Mean BMI = 24.9
(normal)
Mean BMI = 23.7
(normal)
Demographics
BMI
11%: in paid employment
13% in unpaid employment
2%: in paid employment
7% in unpaid employment
7%: in paid employment
13% in unpaid employment
Employment status
(paid vs. unpaid)
Family status
(top 2)
Drug/alcohol use
30% living alone /
independently
8% living with partner
and children
51% no use
25% mild use
17% moderate use
6% severe
33% living alone /
independently
4% living with partner
and children
30% no use
23% mild use
35% moderate use
10% severe
Source: Patient record forms. Fully adherent (n=445), partially (n=162), not at all adherent (n=15)
47% living alone /
independently
7% living with partner
and children
40% no use
33% mild use
27% moderate use
0% severe
CAUTION: Low bases (<n=30)
46
PRF
Patients who have lower level of adherence tend to have higher
number of relapses and rate of hospitalisation. They also have
lower level of insight
B1to B5: disease profile
Timeframes
Relapse
s
Current severity
Fully adherent
Partially adherent
Not at all adherent
Age at diagnosis: 28
Years in psychiatrists care: 3.0
Age at diagnosis: 28
Years in psychiatrists care: 2.5
Age at diagnosis: 28
Years in psychiatrists care: 2.8
Number of relapses: 0.6
Number of relapses: 1
Number of relapses: 1.2
Normal / borderline ill: 35%
Moderate: 61%
Severely ill: 4%
Normal / borderline ill: 13%
Moderate: 80%
Severely ill: 7%
Normal / borderline ill: 0%
Moderate: 80%
Severely ill: 20%
Insight
Full aware: 42%
Moderately aware: 44%
Fully unaware: 14%
Hospitalisations
Ever hospitalised: 77%
Never hospitalised: 20%
Full aware: 19%
Moderately aware: 60%
Fully unaware: 21%
Ever hospitalised: 81%
Never hospitalised: 15%
Source: Patient record forms. Fully adherent (n=445), partially (n=162), not at all adherent (n=15)
Full aware: 7%
Moderately aware: 47%
Fully unaware: 47%
Ever hospitalised: 87%
Never hospitalised: 13%
CAUTION: Low bases (<n=30)
47
PRF
Prescribing of LAIs does not seem to be linked particularly to level of adherence.
Patients who have lower level of adherence are more likely to be prescribed atypical
orals. They are also more likely to be receiving more than 1 treatment
B22 Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?
Fully adherent – 39%
Atypical LAIs
(n=117)
26%
Typical LAIs (n=89)
aripiprazole (n=39)
Typical orals (n=27)
6%
Mean # treatments = 1.1
% on more than 1 treatment = 12%
20%
18%
57%
9%
Not at all adherent - 22%
17%
20%
Atypical orals
(n=253)
Partially adherent – 39%
33%
71%
12%
11%
Mean # = 1.2
% on more than 1 = 83%
80%
13%
7%
Mean # = 1.7
% on more than 1 = 40%
Source: Patient record forms. Fully adherent (n=445), partially (n=162), not at all adherent (n=15)
CAUTION: Low bases (<n=30)
Note: data taken from total sample (not representative sample). Therefore figures are not indicative of market share
48
PRF
Patients who have lower level of insight are more likely to be male,
not be in employment and have higher use of drugs / alcohol
B1to B5: demographics
Fully aware
Moderately aware
(high insight)
Fully unaware
(low insight)
41% female and 59% male
Average age: 40
Age at diagnosis: 28
34% female and 66% male
Average age: 38
Age at diagnosis: 28
39% female and 61% male
Average age: 45
Age at diagnosis: 28
Mean BMI = 25.1
(overweight)
Mean BMI = 24.8
(normal)
Mean BMI = 25.2
(overweight)
Demographics
BMI
18%: in paid employment
17% in unpaid employment
5%: in paid employment
12% in unpaid employment
3%: in paid employment
2% in unpaid employment
Employment status
(paid vs. unpaid)
Family status
(top 2)
Drug/alcohol use
32% living alone /
independently
10% living with partner
and children
32% living alone /
independently
6% living with partner
and children
26% living alone /
independently
4% living with partner
and children
52% no use
29% mild use
14% moderate use
3% severe
37% no use
24% mild use
28% moderate use
8% severe
55% no use
18% mild use
18% moderate use
8% severe
Source: Patient record forms. Fully aware (n=214), moderately (n=295), fully unaware (n=106)
49
PRF
Patients who have lower level of insight tend to have a higher
number of relapses, rate of hospitalisation and have lower level of
adherence
B1to B5: disease profile
Fully aware
Moderately aware
(high insight)
Fully unaware
(low insight)
Age at diagnosis: 28
Years in psychiatrists care: 3.4
Age at diagnosis: 28
Years in psychiatrists care: 2.5
Age at diagnosis: 31
Years in psychiatrists care: 2.4
Number of relapses: 0.5
Number of relapses: 0.8
Number of relapses: 1.1
Normal / borderline ill: 47%
Moderate: 52%
Severely ill: 0.5%
Normal / borderline ill: 23%
Moderate: 74%
Severely ill: 3%
Normal / borderline ill: 11%
Moderate: 69%
Severely ill: 20%
Adherence
Full adherent: 86%
Partially adherent: 14%
Non-adherent: 0%
Full adherent: 65%
Partially adherent: 33%
Non-adherent: 4%
Full adherent: 61%
Partially adherent: 33%
Non-adherent: 7%
Hospitalisations
Ever hospitalised: 73%
Never hospitalised: 22%
Ever hospitalised: 80%
Never hospitalised: 16%
Ever hospitalised: 83%
Never hospitalised: 11%
Timeframes
Relapse
s
Current severity
Source: Patient record forms. Fully aware (n=214), moderately (n=295), fully unaware (n=106)
50
PRF
Lower likelihood to be prescribed atypical orals in patients who are
fully unaware
B22: Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?
Fully aware – 38%
Moderately aware – 47%
(high insight)
Atypical LAIs
Typical LAIs
Aripiprazole
(low insight)
21%
24%
13%
Atypical orals
Mean # treatments = 1.1
% on more than 1 treatment = 11%
27%
20%
65%
10%
Fully unaware -15%
25%
60%
10%
Mean # = 1.1
% on more than 1 = 13%
55%
7%
Mean # = 1.1
% on more than 1 = 18%
Source: Patient record forms. Fully aware (n=214), moderately (n=295), fully unaware (n=106)
Note: data taken from total sample (not representative sample). Therefore figures are not indicative of market share
51
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
52
Section summary








Based on the PRFs, olanzapine and risperidone are the most widely prescribed oral
treatments. Risperdal Consta and typicals are the most widely prescribed LAI
medications
Previous prescribing was higher for the typicals (orals and LAI). Risperidone and
olanzapine are also common previous treatments
The majority of prescriptions are repeat, but nearly 30% of aripiprazole prescriptions
are new
The main reason for prescribing is to treat positive symptoms. Treating general
attributes is also a key driver for LAI treatments
With regards to symptoms, delusions is the major reason a drug is prescribed.
Although not in the overall top ten, low risk of metabolic side effects is a key driver for
prescribing aripiprazole (53%)
Over 70% of patients are prescribed an LAI due to poor adherence with oral therapy
The main reason for switching away from previous treatment is poor tolerability and
side effects. Mode of administration is a key driver for LAIs
Weight gain is a major side effect across all treatments though extrapyramidal side
effects are also a key side effect for LAIs. Over half of patients on aripiprazole do not
experience side effects
53
PRF
Current prescribing: Based on the PRFs, olanzapine and risperidone
are the most widely prescribed oral treatments. Risperdal Consta
and typicals are the most widely prescribed LAI medications
B22: Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for
schizophrenia?
Oral treatments
OLANZAPINE
24%
RISPERIDONE
15%
QUETIAPINE
17%
ARIPIPRAZOLE
3%
PALIPERIDON
E PALMITATE
1%
15%
OLANZAPINE
PAMOATE
1%
AMISULPRIDE
1%
7%
ZIPRASIDONE
0%
ASENAPINE
0%
OTHER
ATYPICAL
OTHER… 0%
TYPICALS
RISPERDAL
CONSTA
21%
CLOZAPINE
PALIPERIDONE
LAI treatments
TYPICALS
6%
9%
Mean # treatments = 1.2
% on more than 1 treatment = 17%
Note that patients can receive more than one drug, hence percentages add up to more than 100%
Source: Patient record form. Representative sample (i.e. minus LAI over-sample)
Base: oral prescriptions (n=394), LAIs prescriptions (n=250)
Mean # = 1.2
% on more than 1 = 17%
Note: this question can be compared
to physician’s estimated prescribing
(question A2, slide 13)
54
PRF
Previous prescribing: Was higher for the typicals (orals and LAI).
Risperidone and olanzapine are also common previous treatments
B35 Previous treatments Which antipsychotic treatment(s) were prescribed as part of the patient’s previous
treatment regimen?
Oral treatments
OLANZAPINE
22%
RISPERIDONE
CLOZAPINE
2%
PALIPERIDON
E PALMITATE
9%
ARIPIPRAZOLE
3%
0%
30% have not
received any
previous
treatment
6%
OLANZAPINE
PAMOATE
0%
AMISULPRIDE
0%
3%
ZIPRASIDONE
0%
ASENAPINE
0%
OTHER
ATYPICAL
OTHER… 1%
TYPICALS
RISPERDAL
CONSTA
18%
QUETIAPINE
PALIPERIDONE
LAI treatments
TYPICALS
10%
16%
Note that patients can receive more than one drug, hence percentages add up to more than 100%
Source: Patient record form. Representative sample (i.e. minus LAI over-sample)
Base: oral prescriptions (n=394), LAIs prescriptions (n=250)
55
PRF
The mean age of patients is ~40 years old. There is no significant
difference in the age of patients by drug type
B1: Please provide the patient’s year of birth (note, the patient must be 18 years of age or over):
Mean age (years)
B22: Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?
39.7
39.2
Total (rep sample) (n=411)
All orals (n=394)
41.5
37.4
All LAIs (n=250)
Source: Patient record form. Representative sample (i.e. minus LAI over-sample)
Base: All PRFs (n=411)
aripiprazole (n=59)
56
PRF
The majority of prescriptions are repeat, but nearly 30% of
aripiprazole prescriptions are new
B24 Current treatment details. Treatment status - start, repeat, switch, re-start?
Other
Switch
Repeat
Restart (have used the drug within the past 6 months)
% of all prescriptions
Start (i.e. newly initiated, not used the drug previously)
8%
9%
7%
54%
63%
6%
14%
38%
74%
61%
59%
44%
25%
100%
13%
5%
21%
Risperdal Consta
(n=19)
9%
12%
11%
26%
25%
paliperidone
palmitate (n=8)
10%
8%
16%
16%
olanzapinepamoate olanzapine (n=87) risperidone (n=74)
(n=0)
clozapine (n=57)
Source: Patient record form, prescription level.
Base: all prescriptions (n=644)
22%
29%
quetiapine (n=64) aripiprazole (n=59) *paliperidone (n=2)
CAUTION: Low bases (n<30)
57
PRF
Detailed analysis of treatments: LAIs
B24 & B36 Drug grids (full text in notes)
LAIs
Risperdal Consta
Mean dose (mg)
Current &
previous
Mean duration of
prescribing
Previous /Current
Formulation
Current &
previous
Mean satisfaction
(1=very poor, 5 =
very good)
Current &
previous
Mean adherence
(1=fully adherent,
3=non-adherent)
Current &
previous
33.4 mg
25.5 / 146 weeks
1.0 % IM acute
injection
99.0 % IM depot
injection
3.8 / 2.9
1.2 / 1.9
100% IM depot
injection
paliperidone
palmitate
81.3 mg
21 / 80 weeks
100% IM depot
injection
3.8 / 2.8
1.1 / 1.8
olanzapine
pamoate
214.2 mg
26 / 61 weeks
11.1 % IM acute
injection
88.9 % IM depot
injection
3.9 / 2.0
1.3 / 2.0
100% IM depot
injection
Source: Patient record forms. Base: LAI prescriptions
58
PRF
The main reason for prescribing is to treat positive symptoms.
Treating general attributes is also a key driver for LAI treatments
B33 Why did you prescribe (drug X) to the patient? Category totals
All treatments - rep sample
To treat - positive
symptoms
Oral treatments
86%
86%
To treat - negative
symptoms
42%
43%
To treat - other
symptoms
39%
42%
Side-effect profile
42%
General attributes
44%
Patient level attributes
49%
LAI treatments
39%
81%
39%
44%
22%
43%
48%
62%
48%
Anticipated positive impact on overall quality of life
Anticipated positive impact on overall functioning (cognitive and social)
Source: Patient record form, prescription level.
Base: oral prescriptions (n=394), LAIs prescriptions (n=250)
59
PRF
Delusions is the major reason a drug is prescribed. Although not in
the overall top ten, low risk of metabolic side effects is a key driver
for prescribing aripiprazole (53%)
B33 Why did you prescribe (drug X) to the patient?
Delusions
Hallucinations
Thought disorder
Anticipated positive impact on overall quality of life
Anticipated positive impact on overall functioning (cognitive and social)
Changes in behaviour
Social withdrawal
Irritability
Low risk of extrapyramidal side effects (including tardive dyskinesia) (not including akathisia)
Lack of interest
71%
71%
68%
67%
57%
55%
52%
41%
41% 39%
36%
28%
27%
23% 23%
45%
42%
40% 40%
44% 43%
44%
40%
40%
37%
39%
35%
29%
29%
30%
25%
22% 23%
41%
36%
26%
21%
25%
18%
10%
Total (rep sample) - (n=446)
All orals (n=469)
Source: Patient record form, prescription level.
Base: oral prescriptions (n=469), LAIs prescriptions (n=302)
All LAIs (n=302)
aripiprazole (n=73)
60
Delusions, hallucinations and thought disorder are the main reasons
for prescribing both oral and LAI treatments
B33 Why did you prescribe (drug X) to the patient?
Orals
Top 3 reasons for
prescribing
LAIs
Top 3 reasons for
prescribing
All orals (n=469)
Delusions 71%, Hallucinations
57%, Thought disorder 44%
All LAI (n=302)
Delusion 67, Hallucinations 52%,
thought disorder 44%
All Atypical orals (n=431)
Delusions 73%, Hallucinations
57%, Thought disorder 44%
Atypical LAIs (n=165)
Delusions 68%, Thought disorder
49%, Hallucinations 48%
risperidone (n=102)
Delusions 75%, Hallucinations
59%, Thought disorder 54%
Risperdal Consta (n=114)
Delusions 66%, Hallucinations
49%, Thought disorder 46%
paliperidone (n=4)
Delusions 100%, Thought
disorder 100%, Frequency of
dosing 75%
paliperidone palmitate (n=34)
Delusions 79%, Frequency of
dosing 65%Thought disorder
62%,
olanzapine (n=114)
Delusions 72%,Hallucinations
51%, Thought disorder 50%
olanzapine pamoate (n=13)
Delusions 69%, Changes in
behaviour 54%, Mode of
administration 46%
Typical LAIs (n=145)
Delusions 62%, Hallucinations
54%, Thought disorder 40%
aripiprazole (n=73)
All typicals (n=64)
Delusions 68%, Low risks of
metabolic side effects (including
weight gain) 53%, Hallucinations
45%
Delusions 50%, Thought disorder
45%, Hallucinations 44%
Source: Patient record form, prescription level.
Base: all prescriptions (n=644) oral prescriptions (n=394), LAIs prescriptions (n=250)
CAUTION: Low bases (<n=30)
61
PRF
Over 70% of patients are prescribed an LAI due to poor adherence
with oral therapy
B26 Why was the patient prescribed a LAI formulation treatment?
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
21%
11%
44%
25%
% of patients
16%
11%
20%
20%
18%
6%
7%
9%
9%
13%
78%
73%
74%
All LAI (n=250)
Atypical LAIs (n=141)
Risperdal Consta
(n=102)
8%
9%
10%
23%
7%
10%
9%
10%
Source: Patient record forms. Base: currently receiving LAI (n=250)
11%
18%
11%
6%
10%
9%
56%
28%
36%
71%
78%
paliperidone palmitate olanzapinepamoate
(n=28)
(n=9)
82%
Typical LAIs (n=112)
CAUTION: Low bases (<n=30)
62
PRF
The main reason for switching away from previous treatment is poor
tolerability and side effects. Mode of administration is a key driver for LAIs
B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?
% of treatments
Don’t know
Mode of administration (i.e. change to different formulation)
Availability of a new treatment option
Patient request
Poor efficacy/symptom control
7%
8%
7%
7%
6%
6%
7%
29%
28%
Other
Inconvenience / not easy to use
Family request
Poor tolerability/complaints about side effect(s)
21%
5%
7%
12%
29%
41%
5%
7%
6%
45%
44%
21%
73%
27%
48%
46%
Total (rep sample) - (n=310)
All orals (n=302)
Source: Patient record forms.
Base: all switched / discontinued treatments (n=483)
36%
All LAIs (n=241)
22%
aripiprazole (n=41)
63
Poor efficacy and symptom control is the main reason for switching
from a patient’s previous regimen for both orals and LAIs
B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?
Orals
All orals (n=302)
All Atypical orals (n=282)
Poor efficacy / symptom control 48%,
poor tolerability 45%, patient request
28%
risperidone (n=58)
paliperidone (n=5)
Poor tolerabily/complaints about side
effect(s) 60%, Patient request 60%,
olanzapine (n=50)
Poor efficacy/symptom control 54%, Poor
tolerability/complaints about side effect(s)
44%, Patient request 34%
All typicals (n=27)
Top 3 reasons for
switching
Poor efficacy / Symptom control 36%,
Mode of administration 29%, Poor
tolerability/complaints about side effect(s)
27%
All LAI (n=241)
Poor efficacy/symptom control 48%, Poor
tolerability/complaints about side effect(s)
46, patient request 29%
Poor tolerability/complaints about side
effect(s) 50%, Poor efficacy/symptom
control 41%, Patient request 26%
aripiprazole (n=41)
LAIs
Top 3 reasons for
switching
Poor tolerability/complaints about side
effect(s) 73%, Patient request 41%,
Poor efficacy/symptom control 22%
Atypical LAIs (n=128)
Mode of administration (i.e. change to
different formula) 36%,Poor
efficacy/symptom control 34%, Poor
tolerability/ complaints about side
effect(s) 23%
Risperdal Consta (n=83)
Mode of administration (i.e. change to
different formula) 41%, Poor
efficacy/symptom control 35%, other
20%
paliperidone palmitate (n=36)
Poor tolerability/ complaints about side
effect(s) 50%, Patient request 28%,
Poor efficacy/symptom control 25%
olanzapine pamoate (n=7)
Poor efficacy/symptom control 57%,
Availability of a new treatment option
43%, Mode of administration(i.e. change
to different formulation) 43%
Typical LAIs (n=113)
Poor efficacy/symptom control 39%, Poor
tolerability/complains about side effect(s)
32%, Patient request 25%
Poor efficacy symptom controls 37%,
Poor tolerability/complaints about side
effect(s) 23%, Patient request 22%
Source: Patient record forms.
Base: all switched / discontinued treatments
CAUTION: Low bases (<n=30)
64
Lack of control of delusions and hallucinations are the main lack of
efficacy reasons resulting in a switch from the previous treatment
B37b Which symptom(s) was [drug X] poor in controlling? – symptoms
Orals
Top 3 uncontrolled
symptoms
LAIs
Top 3 uncontrolled
symptoms
All orals (n=144)
Delusions 74%, Hallucinations 62%,
Thought disorder 41%
All LAI (n=87)
Delusions 74%, Hallucinations 55%,
Thought disorder 38%
All Atypical orals (n=136)
Delusions 74%, Hallucinations 62%,
Thought disorder 43%
Atypical LAIs (n=43)
Delusions 77%, Hallucinations 47%,
Thought disorder 42%
Risperidone (n=24)
Delusions 71%, Hallucinations 46%,
Thought disorder 38%
Risperdal Consta (n=29)
Delusions 79%, Hallucinations 48%,
thought disorder 31%
*paliperidone (n=1)
Thought disorder 100%, Disorganised
speech 100%
paliperidone palmitate (n=9)
olanzapine (n=27)
Delusions 78%, Thought disorder 70%,
Hallucinations 52%
olanzapine pamoate (n=4)
aripiprazole (n=9)
All typicals (n=10)
Hallucinations 67%, Delusions 44%,
emotional flatness 44%
Delusions 67%, Thought disorder 67%,
Social withdrawal 56%
Delusions 75%, Irritability 75%
Delusions 70%, Hallucinations 64%,
Thought disorder 34%
Typical LAIs (n=44)
Delusions 60%, Hallucinations 50%,
Source: Patient record forms. Base: previous treatments that were switched due to poor efficacy / symptom control
CAUTION: Low bases (<n=30)
65
PRF
Main side effects are sedation and weight gain. Over half of patients
on aripiprazole do not experience side effects
B23: Please indicate which side effects the patient has experienced as a result of taking [drug X], if any?
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
38%
% of patients
37%
56%
36%
29%
29%
26%
25%
23%
22%
19%
16%
12%
9%
9%
7% 6%
9%
5%
1%
8%9%
7%
2%
Total (rep sample) - (n=446)
5%
1%
All orals (n=469)
Source: Patient record form, prescription level.
Base: oral prescriptions (n=469), LAIs prescriptions (n=302)
2%
6%
12%
14%
7%
4%
4%
1%
All LAIs (n=302)
15%
5%
0%
1%
aripiprazole (n=73)
66
Weight gain is a major side effect across all treatments though
extrapyramidal side effects are also a key side effect for LAIs
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=469)
Sedation 29%, Weight gain
25%, Metabolic side effects
(excluding weight gain) 9%
38%
All Atypical orals
(n=431)
Sedation 30%, Weight gain
25%, Metabolic side effects
(excluding weight gain) 9%
38%
risperidone (n=102)
Sedation 22%, Weight gain
18%, Prolactin-related side
effects (including sexual
disfunction) 18%
*paliperidone (n=4)
Prolactin-related side effects
including sexual dysfunction)
50%
50%
Weight gain 48%, Sedation
37%, Metabolic side effects
(excluding weight gain) 13%
30%
Sedation 15%, Akathisia
14%, Weight gain 12%
56%
Weight gain 28%,
Extrapyramidal side effects
(including tardive dyskinesia)
(not including akathisia)
28%, sedation 20%,
34%
olanzapine (n=114)
aripiprazole (n=73)
All typicals (n=64)
LAIs
% No side
effects
Weight gain 23%,
Extrapyramidal side effects
(including tardive dyskinesia)
(not including akathisia) 22%,
Sedation 19%
36%
Atypical LAIs (n=165)
Weight gain 24%, Sedation
15%, Extrapyramidal side
effects (including tardive
dyskinesia) (not including
akathisia, 9%
39%
Risperdal Consta (n=115)
Weight gain 24%, Sedation
18%, Prolactin-related side
effects (including sexual
dysfunction) 17%
35%
paliperidone palmitate
(n=34)
Weight gain 21%, Akathisia
18%
50%
olanzapine pamoate
(n=13)
Weight gain 38%, Akathisia
15%,
54%
Typical LAIs (n=145)
Extrapyramidal side effects
(including tardive dyskinesia)
(not including akathisia
37%Weight gain 22%, Sedation
22%
30%
All LAI (n=302)
35%
Source: Patient record form, prescription level.
Base: oral prescriptions (n=469), LAIs prescriptions (n=302)
Top 3 side effects
CAUTION: Low bases (<n=30)
67
Report contents
Physician insights
• Physician profiling
• Based on physician’s perception: insight and adherence
Patient insights (based on PRFs)
• Patient and disease profiling
• Patient journey
• Patient analysis by level of insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
68
PRF
Over half of patients on Risperdal Consta were previously on the oral formulation of the
same drug. Over half of patients receiving typical LAIs were switched from an oral
version of a different drug
B25 What treatment was the patient (currently on LAI), receiving before their LAI medication?
Don’t know
No previous treatment
Oral formulation of a different drug
Oral formulation of the same drug
12%
7%
% of patients
11%
9%
10%
8%
10%
10%
5%
Another LAIs treatment
11%
18%
11%
29%
7%
11%
13%
21%
28%
40%
64%
54%
67%
55%
45%
Risperidone (n=10)
Olanzapine (n=7)
29%
9%
All LAIs (n=250)
Atypical LAIs
(n=141)
Risperdal Consta
(n=102)
Source: Patient record forms. Base: currently receiving LAI (n=250)
Paliperidone
palmitate (n=28)
Olanzapine
Pamoate (n=9)
Typical LAIs
(n=112)
CAUTION: Low bases (<n=30)
69
PRF
Satisfaction with adherence and / or response to oral therapy are the
main reasons why patients are not on an LAI
B28 Why is the patient not currently on a LAI formulation treatment?
Satisfactory adherence with oral therapy
51%
Satisfactory treatment response to oral therapy
41%
Patient unwillingness
32%
I never offered a depot formulation to the patient
15%
% of patients
The right drug is not available as a depot formulation
11%
Patient current condition/symptoms
5%
Family unwillingness
4%
Practical reason e.g. not being able to attend hospital for injection
2%
Formulary restrictions
1%
Cost/reimbursement
1%
Unsure how to approach injections with the patient
1%
Low experience / familiarity with depot treatment
0%
Other
Source: Patient record forms. Base: patients not currently receiving LAI (n=352)
8%
70
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71