Download Marketing Planning Framework

H. LUNDBECK A/S
Schizophrenia Treatment
Landscape Study
Final country report – Germany
Q1 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 Nervenärzte 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)
PRFs (n)
Germany
102
587
Representative LAI oversample
sample PRFs (n)
PRFs (n)
393
194
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
Germany
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
329 (88%)
32 (9%)
31 (8%)
17 (5%)
Country
Germany
LAI oversample*
Oral (n) –
Atypicals
Oral (n) - Typicals
29 (15%)
12 (6%)
LAI (n) – Atypicals LAI (n) - Typicals
153 (79%)
43 (22%)
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 (Germany
only)
• Nervenärztes : 30% + time spent in
psychiatry
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
• Actively managing and treating patients
with schizophrenia (decision maker)
• Seen by physician within the last 24
months (from date of interview)
• Treating 10 or more schizophrenia patients
per month
• Over-sample on patients receiving LAI
treatments:
• Majority of physicians LAI initiators
• Qualified for 3-30 years
• Representative mix of practice settings
and regions within each market
• 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
Data from this study have a good correlation
with IMS data
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
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)
B: Patient record forms (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 - Germany
SETTING


The majority of physicians’ time is spent working in private practice or hospital setting (mainly
acute), and around half of their time is spent with mostly out-patients
Around half of all patients are stable with residual symptoms. Over two-thirds of patients on all
treatment options have not had a relapse in the last 12 months
MARKET SHARE

Most commonly prescribed orals are olanzapine and risperidone. Risperdal Consta is the most
prescribed LAI. Previous prescribing was higher for the typicals (especially orals). Risperidone and
olanzapine are also common previous treatments
SWITCHING


Poor tolerability, patient request and poor efficacy/symptom control are the main reasons for
switching away from previous treatment.
Poor adherence with oral therapy is the main reason for prescribing LAIs, though more convenient
dosing form is a key driver for paliperidone palmitate
INSIGHT

51% of patients are fully aware of their condition, 42% moderately aware and only 7% fully
unaware. This is better than physicians’ original estimates
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 adherence and insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
9
Part A: Key take away message summary








All physicians initiate (prescribe) LAI treatments
The majority of physicians’ time spent working in private practice or hospital setting
(mainly acute), and ~half of their time is spent with mostly out-patients
Presence of side effects and lack of insight are perceived to be the two main reasons
for low patient adherence to treatment
Re-engaging with caregiver/support network is thought to be an effective tool in
improving patient adherence
The majority of physicians were familiar with the term ‘anosognosia’; most commonly
defined as ‘lack of awareness of/insight into condition/disability’
Physician’s estimate that 80% of patients are fully or moderately aware of their
schizophrenia, and awareness can improve even in those with very low levels of
insight
When asked directly, a patient’s level of insight has a major impact on prescribing
decisions, with around three-quarters of physicians more likely to prescribe an LAI to a
patient with a low level of insight than a high level of insight
A low level of insight is considered by over half of respondents to result in nonadherence to treatment and general worsening of symptoms
10
Physician profiling
Physicians tend to have around 14 years of experience. Patients diagnosed with
schizophrenia account for 26% of their total (monthly) caseload. LAI initiation is
100%
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 depot treatment for patients with schizophrenia?
Monthly caseload (S3) (n = 102)
LAI initiation (S5) (n = 102)
100%
14.1 years in practice
Source: Physician profiling. Base: all (n=102)
Non-LAI
initiator
LAI initiator
0%
% of physicians
Years qualified (S2) (n = 102)
SZ patients represent 26% of a
physician’s total caseload
11
Physician profiling
The majority of physicians’ time in Germany is spent working in private
practice 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?
16%
Hospital
Day Hospital
Acute care 27%
Chronic care 9%
Mix
Intermediary 3%
Supply: Hospital
Pharmacy
Supply: Hospital
Pharmacy
54%
Relapse
Ambulatory
Service 16%
Supply: retail
Pharmacy
Source: Physician profiling. Base: all (n=102)
31%
Mostly inpatients
%
Supply: retail
Pharmacy
Private
practice 45%
Mostly-outpatients
12
Physician profiling
Physicians estimate that the most commonly prescribed orals are
quetiapine, olanzapine and risperidone; Risperdal Consta is
estimated as the most 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
21%
OLANZAPINE
13%
11%
CLOZAPINE
QUETIAPINE
(Seroquel)
22%
ARIPIPRAZOLE
(Abilify)
PALIPERIDONE
PALMITATE
7%
12%
2%
OLANZAPINE
PAMOATE
3%
8%
AMISULPRIDE
ZIPRASIDONE
(Zeldox)
RISPERDAL
CONSTA
21%
RISPERIDONE
PALIPERIDONE
(Invega)
LAI treatments
5%
ASENAPINE
(Saphris)
2%
Other atypicals
2%
OTHER
ATYPICAL
Note that patients can receive more than one drug, hence percentages add up to more than 100%
Source: Physician profiling. Base: all (n=102)
1%
Note: this question can
be compared to actual
prescribing collected in
the patient record forms
(question B22, slide 54)
13
Physician profiling
Control of negative symptoms is the main unmet need as perceived by physicians
in Germany. Control of metabolic side effects, and relapse prevention/maintaining
treatment response is also considered to be important by ~two-thirds 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
Control of negative symptoms
75%
Control of metabolic side effects (including weight gain)
65%
Relapse prevention/maintaining treatment response
62%
Patient adherence
55%
Overall quality of life
53%
Patient satisfaction with treatment
40%
Level of functioning (e.g. in social situations, being able to live…
37%
Availability of atypical depots
35%
Early treatment response
34%
Control of positive symptoms
29%
Control of sedation
29%
Control of extrapyramidal side effects (including tardive…
23%
Control of prolactin-related side effects (including sexual…
22%
Cost/reimbursement
19%
Control of aggressive symptoms (e.g. hostility and agitation)
10%
Frequency of dosing
9%
Transition from oral to depot medication
9%
Control of akathisia
9%
Requirement for blood monitoring and/or liver function/liver…
Mode of administration
Source: Physician profiling. Base: all (n=102)
7%
3%
14
Physician profiling
Presence of side effects and lack of insight are perceived to
be the two main reasons for low patient adherence to treatment
A6 What do you think are the main reasons for patients not adhering or only partially adhering to their treatment regimen?
77%
Presence of side effects
74%
Not aware of illness (no insight into disease)
48%
Belief that they are cured (lack of insight)
Concerns about potential side effects
42%
Forgetting to take their medication
42%
Other disease symptom(s) affecting ability to take medication
(e.g. delusions, hallucinations)
39%
Aware of illness/symptoms, but does not recognise the need for
treatment
38%
Aware of illness/symptoms, but unwilling to accept that they
have schizophrenia
31%
Cognitive impairment (not related to their schizophrenia e.g.
dementia, learning disability)
22%
18%
Lack of family support
14%
Drug/alcohol abuse
12%
Complicated medication regimens
Cost of medication
Other, please specify
2%
4%
Related to the disease itself (n=2)
Lack of efficacy (n=2)
% of physicians
Source: Physician profiling. Base: all (n=102)
15
Physician profiling
Re-engaging with caregiver/support network is thought to be an
effective tool in improving patient adherence. Discussion with the
patient is also believed to play a large role in the process
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
Re-engage caregiver/support network
Do not personally use
67%
Discuss reasons for non-adherence with patient
32%
63%
Switch to depot injection
37%
58%
40%
Simplify
medication routine
56%
44%
Switch to other oral antipsychotic with perceived improved effect
56%
Switch to other oral antipsychotic with fewer side effects
55%
Adjust the dose
Initiate/add cognitive behavioural therapy (CBT)
Others include:
High frequency of visits (n=6)
Psychological education (n=4)
Source: Physician profiling. Base: all (n=102)
Other (n=11)
39%
44%
46%
54%
26%
16%
5%
58%
37%
% of physicians
16%
47%
16
Physician profiling
The majority of physicians are familiar with and can define the term
‘anosognosia’. 80% of physicians defined it as ‘lack of awareness
of/insight into condition/disability’
A8 Are you familiar with the term ‘anosognosia’?
% of physicians
Yes, to me this means…
75%
23%
2%
Yes, I have heard of it but not sure
what it means
No, not at all
Yes, to me this means… (coded responses)
80%
13%
Lack of awareness
of/insight into
condition/disability
Denial of illness
4%
3%
Lack of awareness of
part of body
Inability/lack of
recognition/ vague
Source: Physician profiling. Base: all (n=102); physicians who gave a definition of anosognosia (n=77)
17
Physician profiling
Perceived knowledge of poor insight
A8: Are you familiar with the term ‘anosognosia’?
Yes, to me this means… (verbatim responses)
“Not acknowledging
that one is ill”
(Psychiatrist,
Germany)
“Disease is not
realised/acknowledged”
(Psychiatrist, Germany)
“Lack of understanding
of the disease in
schizophrenia”
(Psychiatrist, Germany)
“Not realizing their
own disease”
(Psychiatrist,
Germany)
“Neglect, not seeing
the deficits”
(Psychiatrist,
Germany)
Source: Physician profiling. Base: physicians who gave a definition of anosognosia (n=77)
18
Physician profiling
Physicians estimate that 42% of patients are fully aware of their
schizophrenia. Physicians feel that awareness can improve even
in those with very low levels of insight
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
38%
20%
% of physicians
42%
Fully unaware
Yes, insight can improve
Yes, insight can improve, but
only to some extent
72%
57%
No, insight cannot improve
33%
27%
Don’t know
1%
Moderately aware
Source: Physician profiling. Base: all (n=102)
7%
3%
Fully unaware
19
Physician profiling
A patient’s level of insight has an impact on prescribing in almost all
physicians. Physicians state that they are more likely to prescribe an
LAI to patients with a low level of insight than a high level
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
70%
Major impact
0%
... a low level of insight
28%
2%
Some impact
No impact at all
% of physicians
77%
23%
... 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=102); right chart – physicians whose treatment decision is influenced by level of insight (n=100)
20
Physician profiling
A low level of insight is considered by over half of respondents to
result in non-adherence to treatment and general worsening of
symptoms
A12 What do you think are the main consequences of a patient’s poor/low level of insight into their schizophrenia?
Non-adherence to treatment
61%
Worsening of symptoms
54%
Lower level of functioning
47%
Lower quality of life (QoL)
38%
Creates mistrust between doctor-patient,
making it more difficult to engage the…
25%
Increased need for caregiver support
24%
Increased workload for treatment team
20%
Lower health-related quality of life (HRQoL)
Other
17%
1%
% of physicians
Source: Physician profiling. Base: all (n=102)
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 adherence and 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=3778)
(n=2204)
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
Part B: Patient & disease profiling - key take
away message summary







64% of the last consultations were scheduled or routine follow-ups with 63% of patients
getting repeat prescriptions
Around half of all patients are stable with residual symptoms, but this is significantly higher
for LAIs (62%) vs. orals (50%)
Overall severity of the disease has significantly improved for all patients since first
consultation. Severity of disease is significantly higher at first consultation for patients on
LAIs vs. patients on orals
Over two-thirds of patients on all treatment options have not had a relapse in the last 12
months
Around 80% of currently stable patients are expected to continue being adherent in the
near future across all treatments
Negative symptoms are most commonly experienced across all treatments. Patients on
typical LAIs experience significantly more positive symptoms (77%) than those on typical
orals (62%)
Around half of patients are fully aware of their schizophrenia, although this is significantly
lower in patients on LAIs compared to orals. Level of patient insight is higher than physician
estimates
24
PRF
Patient profile: There is a male bias in the sample. 19% of patients are in
paid employment. There is a significantly higher drug/alcohol use in LAI
patients compared to oral patients
B1 to B5: demographics
Demographics
BMI
Employment status
(paid vs. unpaid)
Family status (top 2)
Drug/alcohol use
All Patients – Total sample
(n=590)
Oral prescriptions
(n=379)
LAI prescriptions
(n=243)
38% female and 62% male
Average age: 39
Age at diagnosis: 27
41% female and 59% male
Average age: 38
Age at diagnosis: 27
34% female and 66% male
Average age: 40
Age at diagnosis: 27
Mean BMI = 25.2
(overweight)
Mean BMI = 25.2
(overweight)
Mean BMI = 25.7
(overweight)
19% in paid employment
21% in unpaid employment
18% in paid employment
21% in unpaid employment
17% in paid employment
21% in unpaid employment
28% living alone /
independently
17% living with parents
42% do not use
29% mild use
19% moderate use
6% severe
Source: Patient record forms. Base: all (n=587)
30% living alone /
independently
17% living with parents
26% living alone /
independently
17% living with partner
without children
45% do not use
30% mild use
16% moderate use
6% severe
38% do not use
28% mild use
23% moderate use
6% severe
• Significantly more LAI patients are reported with moderate drug/alcohol
use than oral patients, at the 5% level
25
PRF
Majority of recent consultations were scheduled or routine followups (64%), and the majority of patients (63%) had their current
treatment regimen 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 (64%)
Treatment repeat (63%)
Orals 62%: LAIs 68%
Orals 63%: LAIs 70%
Acute episode /relapse (21%)
Treatment change (15%)
Orals 24%: LAIs 16%
Orals 17%: LAIs 12%
Diagnosis (10%)
Treatment initiation (12%)
Orals 9%: LAIs 6%
Orals 11%: LAIs 7%
Referral (5%)
Treatment restart (6%)
Orals 5%: LAIs 8%
Orals 6%: LAIs 5%
Side effects (5%)
Stop treatment (2%)
Orals 5%: LAIs 5%
Orals 0%: LAIs 1%
Reason
Source: Patient record forms. Base: all patients – rep sample (n=393)
Action
26
PRF
Around half of all patients are stable with residual symptoms. This is
significantly higher for patients on LAIs vs. patients on orals
B12a/b: Current status
Please indicate the current status of the patient’s schizophrenia using the following options:
• Significantly more LAI patients are stable with residual symptoms than oral patients, at the 1% level
• Significantly more oral patients are stable without residual symptoms than LAI patients, at the 5% level
Acute
Stable with residual symptoms
Stable without residual symptoms
Other
62%
50%
% of patients
48%
40%
33%
27%
25%
24%
22%
21%
20%
15%
3%
Total (rep sample) - (n=393)
3%
All orals (n=379)
2%
All LAIs (n=243)
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
3%
aripiprazole (n=67)
27
PRF
The overall severity of the disease has significantly improved for all
patients since first consultation. Severity of disease is significantly
higher at first consultation for patients on LAIs vs. patients on orals
B11: How would you rate the severity of the patient’s schizophrenia? Please answer on a scale of 1-7.
• Severity of disease has significantly improved for all patients since first consultation, at the 1% level
• Severity of disease is significantly higher for LAI patients than for oral patients at first consultation, at the 5% level
4.7
4.7
4.9
4.8
Mean score
Extremely
mentally ill
(7)
3.8
3.9
4.1
4.0
All patients - rep sample (n=393)
All orals (n=379)
All LAIs (n=243)
aripiprazole (n=67)
Normal, not
at all
mentally ill
(1)
At first consultation
Current severity
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
28
PRF
Over two-thirds of patients on all treatment options have not had a
relapse in the last 12 months
B8b: How many psychotic relapses has the patient experienced in the past 12 months?
Mean # relapses
0.5
0.6
0.5
0.5
9%
11%
12%
8%
22%
15%
22%
% of patients
21%
6 - 10 relapses
2 - 5 relapses
1 relapse
69%
66%
72%
68%
0 relapses
Total (rep sample) - (n=369)
All orals (n=354)
All LAIs (n=227)
Source: Patient record forms. Base: All patients – rep sample (n=369). aripiprazole prescriptions (n=63)
Aripiprazole (n=63)
29
PRF
In patient circumstances, relationship with physician is rated most positively;
this is significantly higher for oral patients vs. LAI patients. LAI patients also
have significantly worse previous treatment response than oral patients
B16a Patient circumstances: Please rate the patient’s situation in relation to the following attributes:
Very high /
very good
(5)
• Orals scored significantly higher than LAIs on relationship with physician, support from family/
friends, socio-economic factors at the 5% level, and previous treatment response at the 1% level
Mean score
4.0 4.0 3.9 4.1
3.4 3.4 3.5 3.3
Very low /
very poor
(1)
Relationship with
physician
Support from
HCPs
All patients - rep sample (n=393)
3.8 3.7 3.7 3.9
3.7
3.5 3.5
3.2
Support from
family / friends
3.1 3.1
2.9
3.1
Socio-economic Current treatment
factors (e.g.
response
financial situation)
All orals (n=379)
All LAIs (n=243)
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
3.6 3.5
3.6
3.3
Previous
treatment
response
Aripiprazole (n=67)
30
PRF
Physicians believe impact on quality of life and ADLs are similar
across patient groups. Impact on social relationships is significantly
higher for patients on LAIs vs. patients on orals
B14 Quality of life: How much impact does the patient’s schizophrenia have on the patient’s…?
Profound
impact
(5)
• A patient’s schizophrenia has significantly more impact on social relationships
if they are on LAIs vs. on orals, at the 5% level
Mean score
3.7 3.7 3.8 3.8
No impact
(1)
Overall quality of life
3.8
3.6 3.7
3.6
3.6
3.4 3.5
3.4
Activities of daily living (e.g.
household chores,
shopping)
All patients - rep sample (n=393)
Social relationships
All orals (n=379)
All LAIs (n=243)
4.0 3.9
3.8 3.9
Ability to work
aripiprazole (n=67)
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
31
PRF
On the whole, the majority of patients who are currently
stable are expected to be very adherent in the future
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?
7%
8%
5%
8%
7%
5%
5%
11%
8%
8%
6%
2%
8%
2%
12%
10%
2%
4%
Don’t know
Yes, I anticipate the patient to
become non-adherent within the
next 6 months
79%
79%
76%
84%
80%
82%
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
Total (rep
sample)
(n=297)
Atypical orals Typical orals
(n=267)
(n=36)
aripiprazole
(n=49)
Atypical LAIs
(n=147)
Typical LAIs
(n=54)
Source: Patient record forms. Base: all patients that are currently stable with/without residual symptoms (n=297)
32
PRF
Negative symptoms are most commonly experienced across all
treatments. Patients on typical LAIs experience significantly more positive
symptoms (77%) than those on typical orals (62%)
B29 Current symptoms
Please indicate which symptoms the patient currently experiences as part of their schizophrenia
• Patients on typical LAIs experience significantly more positive symptoms than patients on typical orals, at the 5% level
• Patients on typical orals experience significantly more other symptoms than patients on aripiprazole, at the 5% level
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)
Mean number
1.3
of symptoms
1.7
% of patients
76%
1.3 1.7
79%
53%
Total (rep sample)
(n=393)
1.2 1.8
1.4 1.8
82%
82%
1.7 2.2
77%
71%
62%
60%
59%
1.4 2.1
53%
Atypical orals
(n=359)
60%
52%
Typical orals
(n=45)
Source: Patient record forms. Base: rep sample (n=393) oral (n=359) versus LAI (n=184)
77%77%
72%
55%
49%
Aripiprazole
(n=67)
Atypical LAIs
(n=184)
Typical LAIs
(n=60)
33
PRF
Based on the PRFs, around half of patients are fully aware of their
schizophrenia, although this is significantly lower in patients on LAIs
compared to orals. Level of patient insight is higher than physician estimates
B15: Is your patient aware that he/she has schizophrenia?
Note: this question can
be compared to A10 in
the physician perception
section (slide 19)
• Significantly more patients on orals are fully aware of their schizophrenia
vs. patients on LAIs, at the 1% level
% of patients
Mean score
2.4
2.4
2.3
7%
7%
10%
2.2
43%
42%
Fully unaware
42%
53%
Moderately aware
Fully aware
51%
57%
51%
37%
Total (rep sample) (n=393)
All orals (n=379)
All LAIs (n=227)
Aripiprazole (n=67)
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
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 adherence and 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
Part B: Patient journey - key take away
message summary






Hospital psychiatrists tend to be responsible for seeing the patients first, diagnosis and
treatment initiation, with office psychiatrists playing a key role in treatment initiation of
typical LAIs
Approximately 50% of patients are currently managed in private practice. Around 1/3
are managed in an out-patient setting; this is significantly more for aripiprazole patients
vs. both atypical and typical orals
Approximately 90% of patients are currently managed by the respondent physician.
Psychiatric nurse involvement is minimal
Duration between symptoms and consultation tends to be much longer than time
between first consultation and diagnosis, and diagnosis to treatment (35 weeks vs. 13
weeks vs.10 weeks)
Around 1/3 of patients have been hospitalised within the last 12 months (including
current hospitalisations)
37% of patients switch from one antipsychotic to another after their stay in hospital.
17% were discharged on a LAI formulation
37
PRF
Hospital psychiatrists play a key role in first seeing patients,
with involvement increasing at diagnosis and treatment initiation.
Office psychiatrists’ involvement is high with initiation of typical LAIs
B10b: And which of the following healthcare professional(s) are/were responsible for each of the following?
First saw / Diagnosed / Initiated treatment
Atypical
First saw
Patients currently on Oral
prescriptions
16%
Diagnosed
22%
Initiated tx
24%
18%
38%
52%
13%
First saw
15% 13%
44%
14%
12%
Diagnosed
22%
58%
8%
9%
Initiated tx
21%
61%
7%
53%
Typical
Typical
First saw
Atypical
Patients currently on LAI
prescriptions
11% 11%
49%
Diagnosed
16%
58%
Initiated tx
16%
56%
Yourself
GP
7%
13%
11%
First saw 10% 8%
38%
Diagnosed 10%
52%
Initiated tx 10%
54%
Other Psychiatrist, Hospital
16%
18%
48%
Other Psychiatrist, Office
“Yourself” indicates that management is by the person
completing the survey. Refer to slide 12 for physician settings
Source: Patient record forms. Base: oral prescriptions (n=379); LAI prescriptions (n=243)
38
PRF
Approximately 50% of patients are currently managed in private practice.
Around 1/3 are managed in an out-patient setting; this is significantly more
for aripiprazole patients vs. both atypical and typical 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)
• Significantly more patients on aripiprazole are managed in an out-patient
clinic vs. patients on both typical and atypical orals, at the 1% level
% of patients
Hospital, acute care
Day hospital
48%
52%
31%
29%
Out-patient clinic
Private practice
56%
45%
22%
40%
Private hospital
47%
34%
57%
30%
4%
3%
3%
16%
17%
Total (rep sample)
(n=393)
Atypical orals
(n=359)
22%
1%
2%
2%
15%
16%
15%
Atypical LAIs
(n=184)
Typical LAIs (n=61)
Typical orals (n=45) Aripiprazole (n=67)
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
39
PRF
Approximately 90% of patients are currently managed by the
respondent psychatrist, with 6% other Nervenärtze currently
involved in Germany. Psychiatric nurse involvement is minimal
B10b Please indicate which of the following Healthcare professionals are responsible for current management of the patients
Yourself
Other psychiatrist, hospital
Neurologist
Geriatrician
Psychiatric nurse
Other
GP_Primary Care Physician
Other psychiatrist, office
Clinical psychologist
Nervenärtze
Paediatrician / adolescent specialist
Don’t know / not applicable
4%
7%
3%
6%
4%
11%
89%
89%
87%
Total (rep sample)
(n=393)
Atypical orals
(n=359)
% of patients
3%
6%
2%
5%
7%
3%
4%
9%
3%
5%
2%
6%
8%
8%
3%
7%
5%
91%
89%
90%
Atypical LAIs
(n=184)
Typical LAIs (n=61)
Typical orals (n=45) aripiprazole (n=67)
“Yourself” indicates that management is by the person
completing the survey. Refer to slide 12 for physician settings
Source: Patient record forms. Base: All patients – rep sample (n=393). aripiprazole prescriptions (n=67)
40
PRF
Duration between symptoms and consultation tends to be much
longer than time between first consultation and diagnosis, and
diagnosis to treatment (35 weeks vs. 13 weeks vs.10 weeks)
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?
Symptoms --> consultation
First consultation --> diagnosis
Diagnosis --> treatment
45
39
35
35
Time
(weeks)
24
18
13
10
11
10
6
1
Total (rep sample) (n=261)
All orals (n=248)
Aripiprazole (n=48)
All LAIs (n=129)
Source: Patient record forms. Base: All patients – rep sample (n=261). aripiprazole prescriptions (n=48)
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 (including current hospitalisations)
When hospitalised:
B17 Has the patient ever been hospitalised for their schizophrenia?
% of patients
Mean number of
hospitalisations in
the last year
1.6
1.5
2.4
1.3
1.5
3.4
4%
3%
2%
1%
4%
2%
19%
13%
20%
19%
17%
13%
44%
44%
44%
21%
21%
51%
43%
67%
22%
11%
13%
Total (rep
sample)
(n=393)
Atypical
orals
(n=359)
13%
18%
27%
10%
15%
Typical orals aripiprazole
(n=45)
(n=67)
9%
8%
Atypical
LAIs
(n=184)
Typical LAIs
(n=61)
Source: Patient record forms. Base: all (n=393); Orals (n=379) versus aripiprazole (n=67) versus LAIs (n=243)
Yellow box - patient record forms for those who have been hospitalised in the last 12 months/duration (n=181/105)
Don't know
No
Yes, more than 12 months ago
Yes, within the last 12 months
Yes, currently hospitalised
42
PRF
37% of patients switched from one antipsychotic to another after their stay in
hospital. 17% were discharged on a LAI formulation (compared to 13%
overall proportion of patients receiving a LAI in Germany)
B21b: Was the patient discharged on a
LAI formulation?
B21a How was the patient’s antipsychotic treatment changed during
his/her stay in hospital?
% of patients
Switch from one antipsychotic to
another
37%
Add-on of an antipsychotic to regimen
15%
11%
9%
Don't know
82%
No
Yes
2%
0%
0%
Other
Don’t know
% of patients
Change in dosing of existing
antipsychotic
Antipsychotic treatment prescribed for
the first time ever
Change in formulation of existing
antipsychotic
Switch from an antipsychotic from
another therapeutic category
Switch to an antipsychotic from another
therapeutic category
Antipsychotic treatment stopped, with
no other therapies initiated
15%
17%
11%
0%
Source: Patient record forms. Base: Representative sample. Patients who
received an antipsychotic treatment change at discharge from hospital
(n=46)
Source: Patient record forms. Base: Representative sample.
Patients who have been hospitalised in last 12 months (n=83)
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 adherence and 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
Profile of patient: Patients who are less adherent are significantly
more likely to have drug/alcohol use, and significantly less likely to
be in paid employment and living alone
B1to B5: demographics
Fully adherent
Demographics
BMI
Employment status
(paid vs. unpaid)
Family status (top 2)
Drug/alcohol use
Partially adherent
Not at all adherent
39% female and 61% male
Average age: 40
Age at diagnosis: 27
36% female and 64% male
Average age: 38
Age at diagnosis: 27
29% female and 71% male
Average age: 37
Age at diagnosis: 29
Mean BMI = 25.3
(overweight)
Mean BMI = 25.5
(overweight)
Mean BMI = 23.7
(normal)
23% in paid employment
19% in unpaid employment
12% in paid employment
24% in unpaid employment
32% living alone /
independently
16% living with partner
without children
15% living with parents
54% no use
28% mild use
12% moderate use
4% severe
5% in paid employment
16% in unpaid employment
23% living alone /
Independently
19% sheltered accommodation
16% living with parents
32% living with parents
21% living alone /
independently
13% living with support from
caregiver
26% no use
32% mild use
29% moderate use
6% severe
18% no use
26% mild use
24% moderate use
26% severe
Source: Patient record forms. Fully adherent (n=360), partially (n=206), not at all adherent (n=38)
46
PRF
Patients who have lower level of adherence are significantly more
severe, and have significantly lower levels of insight. They also appear to
have a higher number of relapses and rate of hospitalisations
B1to B5: disease profile
Fully adherent
Partially adherent
Not at all adherent
Timeframes
Age at diagnosis: 27
Years in current psychiatrists'
care: 3.9
Age at diagnosis: 27
Years in current psychiatrists'
care: 4.2
Age at diagnosis: 29
Years in current psychiatrists'
care: 3.6
Relapses in
last year
Number of relapses: 0.4
Number of relapses: 0.7
Number of relapses: 1.4
Normal / borderline ill: 17%
Moderate: 73%
Severely ill: 10%
Normal / borderline ill: 6%
Moderate: 78%
Severely ill: 16%
Normal / borderline ill: 5%
Moderate: 68%
Severely ill: 26%
Insight
Full aware 61%
Moderately aware: 36%
Fully unaware: 3%
Full aware 25%
Moderately aware: 64%
Fully unaware: 11%
Full aware: 8%
Moderately aware: 55%
Fully unaware: 37%
Hospitalisations
Ever hospitalised: 77%
Never hospitalised: 20%
Ever hospitalised: 80%
Never hospitalised: 15%
Ever hospitalised: 87%
Never hospitalised: 13%
Current severity
Source: Patient record forms. Fully adherent (n=360), partially (n=206), not at all adherent (n=38)
47
PRF
Prescribing behaviour does not seem to be influenced by level
of adherence
B22 Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?
Fully adherent – 61%
Atypical LAIs
Typical LAIs
36%
Typical orals
8%
Mean # treatments = 1.26
% on more than 1 treatment = 21%
47%
13%
61%
12%
Not at all adherent – 6%
26%
11%
Atypical orals
aripiprazole
Partially adherent – 35%
8%
73%
13%
58%
5%
12%
Mean # = 1.36
% on more than 1 = 30%
13%
Mean # = 1.37
% on more than 1 = 37%
Source: Patient record forms. Fully adherent (n=360), partially (n=206), not at all adherent (n=38)
Note: data taken from total sample (not representative sample). Therefore figures are not indicative of market share
48
PRF
Patients who have higher level of insight are more significantly
more likely to be in paid employment, living independently, and not
using drugs/ alcohol vs. patients with lower levels of insight
B1to B5: demographics
Fully aware
(high insight)
Demographics
BMI
Employment status
(paid vs. unpaid)
42% female and 58% male
Average age: 38
Age at diagnosis: 27
Mean BMI = 25.0
(overweight)
32% in paid employment
21% in unpaid employment
Fully unaware
36% female and 64% male
Average age: 39
Age at diagnosis: 27
31% female and 69% male
Average age: 39
Age at diagnosis: 28
Mean BMI = 25.7
(overweight)
Mean BMI = 23.7
(normal)
8% in paid employment
20% in unpaid employment
36% living alone /
independently
12% living with parents
22% living alone /
independently
19% living with parents
55% no use
31% mild use
12% moderate use
1% severe
31% no use
30% mild use
27% moderate use
7% severe
Family status (top 2)
Drug/alcohol use
Moderately aware
Source: Patient record forms. Fully aware (n=276), moderately (n=264), fully unaware (n=49)
(low insight)
2% in paid employment
20% in unpaid employment
16% living alone /
independently
31% living with parents
31% no use
16% mild use
20% moderate use
22% severe
49
PRF
Patients who have higher levels of insight have significantly lower
severity, higher levels of adherence, and less hospitalisations. They
also appear to have a lower number of relapse each year
B1to B5: disease profile
Fully aware
Moderately aware
(high insight)
Fully unaware
(low insight)
Timeframes
Age at diagnosis: 27
Years in current psychiatrists'
care: 3.9
Age at diagnosis: 27
Years in current psychiatrists'
care: 3.9
Age at diagnosis: 28
Years in current psychiatrists'
care: 2.8
Relapses in
last year
Number of relapses: 0.3
Number of relapses: 0.6
Number of relapses: 1.2
Normal / borderline ill: 23%
Moderate: 72%
Severely ill: 5%
Normal / borderline ill: 6%
Moderate: 77%
Severely ill: 17%
Normal / borderline ill: 4%
Moderate: 59%
Severely ill: 37%
Adherence
Full adherent: 80%
Partially adherent: 19%
Non-adherent: 1%
Full adherent: 46%
Partially adherent: 47%
Non-adherent: 16%
Full adherent: 24%
Partially adherent: 47%
Non-adherent: 29%
Hospitalisations
Ever hospitalised: 73%
Never hospitalised: 24%
Ever hospitalised: 82%
Never hospitalised: 14%
Ever hospitalised: 73%
Never hospitalised: 14%
Current severity
Source: Patient record forms. Fully aware (n=276), moderately (n=264), fully unaware (n=49)
50
PRF
Patients with lower level of insight are more likely to receive atypical
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?
Fully aware – 47%
Moderately aware – 45%
(high insight)
Atypical LAIs
Typical LAIs
Aripiprazole
Typical orals
(low insight)
28%
36%
7%
Atypical orals
6%
Mean # treatments = 1.17
% on more than 1 treatment = 18%
40%
14%
70%
14%
Fully unaware – 8%
13%
58%
11%
51%
0%
9%
Mean # = 1.26
% on more than 1 = 22%
11%
Mean # = 1.12
% on more than 1 = 20%
Source: Patient record forms. Fully aware (n=276), moderately (n=264), fully unaware (n=49).
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 adherence and insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
52
52
Part C: Overall prescribing, reasons for prescribing
and switching - key take away message summary








Most commonly prescribed orals are olanzapine and risperidone. Risperdal Consta is the
most prescribed LAI. Previous prescribing was higher for the typicals (especially orals).
Risperidone and olanzapine are also common previous treatments
The mean age of patients in Germany is 38 years old. Patients prescribed aripiprazole are
significantly younger than patients on oral treatments
The majority of all prescriptions are repeat
Treating positive symptoms is the most common reason for prescribing, especially for oral
treatments. General attributes is significantly more of an important driver for LAI prescribing
Delusions and hallucinations are major reasons for prescribing current treatment. For
aripiprazole, lack of interest, social withdrawal and inability to concentrate are significantly
more important than for orals
Poor adherence with oral therapy is the main reason for prescribing LAIs, though more
convenient dosing form is a key driver for paliperidone palmitate
Poor tolerability, patient request and poor efficacy/symptom control are the main reasons
for switching away from previous treatment. Poor tolerability and poor efficacy are stronger
reasons for orals
Weight gain and sedation are the main side effects experienced. Over half of patients
receiving aripiprazole do not experience any side effects; this is significantly more than
patients on orals
53
PRF
Current prescribing: Most commonly prescribed orals are
quetiapine, olanzapine and risperidone. Risperdal Consta is the
most prescribed LAI
B22: Current treatments Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for
schizophrenia?
Oral treatments
OLANZAPINE
19%
RISPERIDONE
12%
QUETIAPINE
19%
ARIPIPRAZOLE
5%
PALIPERIDONE
PALMITATE
2%
16%
OLANZAPINE
PAMOATE
1%
AMISULPRIDE
ZIPRASIDONE
RISPERDAL
CONSTA
18%
CLOZAPINE
PALIPERIDONE
LAI treatments
2%
10%
OTHER
ATYPICAL
3%
ASENAPINE
OTHER… 1%
TYPICALS
TYPICALS
5%
9%
Mean # treatments = 1.37
% on more than 1 treatment = 31%
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=379), LAIs prescriptions (n=243)
Mean # = 1.28
% on more than 1 = 23%
Note: this question can be compared
to physician’s estimated prescribing
(question A2, slide 13)
54
PRF
Previous prescribing: Previous prescribing was higher for the
typicals (especially orals). 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
15%
RISPERIDONE
14%
CLOZAPINE
RISPERDAL
CONSTA
1%
5%
QUETIAPINE
PALIPERIDONE
PALMITATE
9%
ARIPIPRAZOLE
0%
6%
OLANZAPINE
PAMOATE
PALIPERIDONE
AMISULPRIDE
ZIPRASIDONE
LAI treatments
0%
5%
1%
OTHER
ATYPICAL
ASENAPINE
44% have not
received any
previous
treatment
0%
OTHER… 1%
TYPICALS
23%
TYPICALS
9%
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=379), LAIs prescriptions (n=243)
55
PRF
The mean age of patients in Germany is 38 years old. Patients
prescribed aripiprazole are significantly younger than patients on
oral treatments
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?
Mean age (years)
• Aripiprazole patients are significantly younger than patients on oral treatments, at the 1% level
38.1
38.2
Total (rep sample) (n=393)
All orals (n=379)
39.7
34.2
All LAIs (n=243)
Source: Patient record form. Representative sample (i.e. minus LAI over-sample)
Base: All PRFs (n=587)
aripiprazole (n=67)
56
PRF
The majority of prescriptions are repeat
B24 Current treatment details. Treatment status - start, repeat, switch, re-start?
Other
5%
7%
Switch
Repeat
Restart (have used the drug within the past 6 months)
5%
7%
9%
% of all prescriptions
19%
49%
Start (i.e. newly initiated, not used the drug previously)
6%
10%
12%
8%
7%
36%
25%
44%
61%
46%
67%
46%
16%
38%
45%
18%
Risperdal consta
paliperidone
olanzapine
(n=107)
palmitate (n=55) pamoate (n=22)
olanzapine
(n=79)
Source: Patient record form, prescription level.
Base: current oral prescriptions (n=379)
100%
7%
50%
13%
18%
67%
61%
5%
8%
7%
13%
12%
8%
10%
12%
clozapine (n=51)
quetiapine
(n=84)
23%
risperidone
(n=77)
7%
25%
12%
aripiprazole
(n=67)
paliperidone
(n=4)
amisulpride
(n=42)
CAUTION: Low bases (<n=30)
asenapine
(n=1)
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
43.2 mg
11.2 / 8.7 months
IM depot injection –
99.1%
IM acute injection –
0.9%
3.7 / 3.4
1.4 / 1.6
4.2 / 2.0
1.3 / 1.8
3.7 / 1.7
1.4 / 1.3
IM depot injection –
90.5%
IM acute injection –
9.5%
paliperidone
palmitate
99.8 mg
7 / 1.8 months
IM depot injection 96.4%
IM acute injection –
3.6%
IM depot injection –
100%
olanzapine
pamoate
290.3 mg
0 / 18 months
Source: Patient record forms, prescription level. Base: LAI prescriptions
IM depot injection
100%
58
PRF
Treating positive symptoms is the most common reason for
prescribing, especially for oral treatments. General attributes is
significantly more of an important driver for LAI prescribing
B33 Why did you prescribe (drug X) to the patient? Category totals
All treatments - rep sample
To treat - positive
symptoms
To treat - negative
symptoms
Oral treatments
77%
77%
55%
45%
44%
Side-effect profile
47%
46%
Patient level attributes
38%
55%
71%
54%
To treat - other
symptoms
General attributes
LAI treatments
38%
48%
44%
33%
55%
56%
47%
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=379), LAIs prescriptions (n=243)
59
PRF
Delusions and hallucinations are major reasons for prescribing current
treatment. For aripiprazole, lack of interest, social withdrawal and inability to
concentrate are significantly more important than for all orals
B33 Why did you prescribe (drug X) to the patient?
• Delusions are significantly stronger reasons for prescribing orals vs. aripiprazole, at the 1% level
• Lack of interest, social withdrawal and inability to concentrate are all significantly stronger reasons for prescribing aripiprazole vs. orals, at the 5%
level
Hallucinations
Delusions
Thought disorder
Changes in behaviour
Disorganised speech
Lack of interest
Social withdrawal
Emotional flatness
Inability to concentrate
Suicidal thoughts
52%
52%
47%
45% 44%
48% 47%
47%
43%
42%
41%
35%
25%
44%
40%
39%
38%
33%
32%
31%
34% 32%
27%
25%
45%
32%
30%
25%
27%
27%
34%
25%
22%
18%
13%
5%
3%
Total (rep sample) - (n=468)
13%
14%
All orals (n= 518)
Source: Patient record form, prescription level.
Base: all PRFs (n=587) oral prescriptions (n=518), LAIs prescriptions (n=309)
All LAIs (n=309)
4%
aripiprazole (n=105)
60
Delusions and hallucinations 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
All orals (n=379)
Delusions – 52%, Hallucinations – 47%,
Anticipated positive impact on overall
quality of life – 46%
All Atypical orals (n=487)
Delusions – 53%, Hallucinations – 47%,
Anticipated positive impact on quality of
life– 47%
risperidone (n=112)
Delusions – 57%, Anticipated positive
impact on overall functioning – 54%,
Thought disorder – 54%
paliperidone (n=5)
Hallucinations – 80%, Lack of interest –
80%, Social withdrawal – 80%,
Emotional flatness – 80%, Inability to
concentrate – 80%
olanzapine (n=103)
Delusions – 55%, Hallucinations – 53%,
Anticipated positive impact on overall
quality of life – 45%
aripiprazole (n=105)
All typicals (n=96)
LAIs
Top 3 reasons for
prescribing
All LAI (n=243)
Hallucinations – 48%, Delusions – 47%,
Thought disorder – 42%
Atypical LAIs (n=224)
Thought disorder – 45%, Hallucinations –
44%, Delusions – 44%,
Risperdal consta (n=134)
Hallucinations – 43%, Thought disorder –
41%, Delusions – 40%
paliperidone palmitate (n=67)
Delusions – 51%, Anticipated positive
impact on overall quality of life – 51%,
Hallucinations – 49%
olanzapine pamoate (n=23)
Thought disorder – 65%, Delusions –
48%, Social withdrawal – 48%, Inability
to concentrate – 48%
Typical LAIs (n=89)
Hallucinations – 57%, Delusions – 55%,
Anticipated positive impact on overall
quality of life – 38%
Anticipated positive impact on overall
functioning – 54%, Anticipated positive
impact on overall quality of life – 52%,
Hallucinations – 45%
Delusions – 44%, Hallucinations – 43%,
Anticipated positive impact on overall
functioning (cognitive and social) – 43%
Source: Patient record form, prescription level.
Base: oral prescriptions (n=518), LAIs prescriptions (n=309)
CAUTION: Low bases (<n=30)
61
PRF
Poor adherence with oral therapy is the main reason for prescribing
LAIs, though more convenient dosing form is a key driver for
paliperidone palmitate, significantly higher than for typical LAIs
B26 Why was the patient prescribed a LAI formulation treatment?
• A more convenient dosing form is a significantly stronger reason for prescribing palperidone palmitate vs. typical LAIs, at the 5% level
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
7%
33%
44%
36%
% of patients
34%
11%
12%
10%
11%
14%
10%
29%
21%
15%
8%
11%
9%
20%
9%
30%
30%
35%
18%
11%
60%
58%
61%
All LAI (n=242)
Atypical LAIs (n=184)
Risperdal consta
(n=107)
Source: Patient record forms. Base: currently receiving LAI (n=242)
27%
18%
14%
14%
25%
23%
8%
7%
8%
41%
25%
27%
24%
77%
65%
45%
paliperidone palmitate olanzapine pamoate
(n=55)
(n=22)
Typical LAIs (n=60)
CAUTION: Low bases (<n=30)
62
PRF
Poor tolerability, patient request and poor efficacy/symptom control are
the main reasons for switching away from previous treatment. Poor
tolerability and poor efficacy are more significant drivers for orals
B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?
• Poor tolerability is a significantly stronger reason for switching/ discontinuing orals vs. LAIs, at the 1% level
• Poor efficacy is a significantly stronger reason for switching/ discontinuing orals vs. both LAIs and aripiprazole, at the 5% level
Poor efficacy/symptom control
Patient request
Availability of a new treatment option
Mode of administration (i.e. change to different formulation)
Don’t know
% of treatments
8%
4%
5%
5%
41%
Poor tolerability/complaints about side effect(s)
Family request
Inconvenience / not easy to use
Other, please specify
9%
6%
3%
5%
5%
27%
38%
12%
12%
9%
3%
5%
5%
45%
33%
56%
53%
30%
55%
38%
42%
34%
28%
Total (rep sample) - (n=264)
All orals (n=255)
All LAIs (n=202)
aripiprazole (n=40)
Source: Patient record forms
Base: all switched / discontinued treatments (n=408)
63
Poor tolerability, patient request and poor efficacy/symptom control are
the main reasons for switching away from previous treatment
B37 Why was (drug X) switched or discontinued from the patient’s previous regimen?
Orals
Top 3 reasons for
switching
All orals (n=255)
Poor tolerability/complaints about side
effects – 56%, Poor efficacy/symptom
control – 42%, Patient request – 38%
All Atypical orals (n=244)
Poor tolerability/complaints about side
effects – 58%, Poor efficacy/symptom
control – 42%, Patient request – 39%
risperidone (n=60)
Poor tolerability/complaints about side
effects – 53%, Patient request – 43%,
Poor efficacy/symptom control – 38%,
paliperidone (n=3)
Poor tolerability/complaints about side
effects – 67%, Patient request – 67%,
Poor efficacy/symptom control – 33%,
Family request – 33%
olanzapine (n=39)
Poor efficacy/symptom control –
59%,Poor tolerability/complaints about
side effects – 56%, Patient request –
38%
aripiprazole (n=40)
All typicals (n=33)
Poor tolerability/complaints about side
effects – 55%, Patient request – 45%,
Poor efficacy/symptom control – 28%,
Patient request – 51%,
Poor efficacy/symptom control – 42%,
Poor tolerability/complaints about side
effects – 36%
Source: Patient record forms , prescription level.
Base: all switched / discontinued treatments
LAIs
Top 3 reasons for
switching
All LAI (n=202)
Poor efficacy/symptom control – 34%,
Patient request – 33%, Poor
tolerability/complaints about side effects
– 30%
Atypical LAIs (n=164)
Patient request – 35%,, Mode of
administration – 28%, Poor
tolerability/complaints about side effects
– 27%
Risperdal consta (n=96)
Patient request – 33%, Poor
efficacy/symptom control – 29%, Poor
tolerability/complaints about side effects
– 29%
paliperidone palmitate (n=50)
Patient request – 38%, Poor
tolerability/complaints about side effects
– 32%, Mode of administration – 28%
olanzapine pamoate (n=18)
Poor efficacy/symptom control – 50%,
Patient request – 39%, Mode of
administration – 33%
Typical LAIs (n=40)
Poor efficacy/symptom control – 68%,
Poor tolerability/complaints about side
effects – 40%, Mode of administration –
28%
CAUTION: Low bases (<n=30)
64
Main efficacy related reasons for switching from previous treatment
are lack of control of delusions, hallucinations and thought disorder
B37b Which symptom(s) was [drug X] poor in controlling? –symptoms
Orals
Top 3 uncontrolled
symptoms
LAIs
Top 3 uncontrolled
symptoms
All orals (n=106)
Delusions – 63%, Thought disorder–
58%, Hallucinations – 54%
All LAI (n=69)
Delusions – 68%, Thought disorder–
65%, Hallucinations – 58%
All Atypical orals (n=102)
Delusions – 62%, Thought disorder–
59%, Hallucinations – 53%
Atypical LAIs (n=43)
Delusions – 65%, Thought disorder–
60%, Hallucinations – 58%
risperidone (n=23)
Delusions – 65%, Hallucinations –
61%,Thought disorder– 43%,
Risperdal consta (n=28)
Delusions – 64%, Hallucinations –
57%,Thought disorder– 54%,
paliperidone (n=1)
Delusions – (100%)
paliperidone palmitate (n=6)
Delusions – 67%, Thought disorder–
67%, Hallucinations – 67%
olanzapine (n=23)
Hallucinations – 65%, Delusions – 61%,
Inability to concentrate - 39%,
olanzapine pamoate (n=9)
Delusions – 78%, Thought disorder–
67%, Hallucinations – 56%
aripiprazole (n=11)
Delusions – 64%, Thought disorder–
64%, Hallucinations – 64% , Lack of
interest – 64%
Typical LAIs (n=27)
Delusions – 74%, Thought disorder–
74%, Hallucinations – 59%
All typicals (n=14)
Delusions – 93%, Thought disorder–
64%, Hallucinations – 64% , Changes in
behaviour – 64%
Source: Patient record forms , prescription level.. Base: previous treatments that were switched due to poor efficacy / symptom control
CAUTION: Low bases (<n=30)
65
PRF
Weight gain and sedation are the main side effects experienced.
Over half of patients receiving aripiprazole do not experience any
side effects; this is significantly more than patients on orals
B23: Please indicate which side effects the patient has experienced as a result of taking [drug X], if any?
• Significantly more patients on aripiprazole experience no side effects than those on orals, at the 1% level
• Patients on aripiprazole experience significantly less weight gain and sedation, but significantly more akathisia than oral patients, at the 5% level
• Patients on LAIs experience significantly more extrapyramidal sside effects and akathisia than oral patients, at the 5% level
No side effects
Weight gain
Sedation
Metabolic side effects (excluding weight gain)
Extrapyramidal side effects (including tardive dyskinesia)
(not including akathisia)
60%
Akathisia
Prolactin-related side effects (including sexual dysfunction)
Injection site reactions
44%
% of patients
43%
28%
26%
43%
27%26%
26%
21%
17%
9% 8%
9%
7% 7%
Total (rep sample) - (n=468)
0%
All orals (n=518)
Source: Patient record form, prescription level.
Base: oral prescriptions (n=518), LAIs prescriptions (n=311)
12%
10%
6%
6%
11%
9%
7%
6% 7% 7%
1% 2%
18%
16%
2%
4%
1%
All LAIs (n=311)
0% 1%
aripiprazole (n=105)
66
Weight gain and sedation are the main side effects
experienced
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
LAIs
Top 3 side effects
All orals (n=518)
Weight gain– 27%, Sedation–
26%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia)– 9%
44%
All LAI (n=311)
Weight gain– 26%, Sedation –
21%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 17%
43%
All Atypical orals (n=487)
Weight gain– 28%, Sedation–
26%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 7%
44%
Atypical LAIs (n=224)
Weight gain– 22%, Sedation –
18%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 9%
53%
risperidone (n=112)
Sedation – 22%, Weight gain –
20%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 14%
44%
Risperdal consta
(n=134)
50%
Sedation – 40%, Prolactin-related
side effects (including sexual
dysfunction) – 20%
Weight gain – 21%, Sedation –
19%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 13%
40%
paliperidone
palmitate (n=67)
Weight gain – 18%, Sedation –
12%, Akathisia – 9%
66%
olanzapine pamoate
(n=23)
Weight gain – 39%, Sedation –
35%, Metabolic side effects
(excluding weight gain) – 26%
35%
Typical LAIs (n=91)
Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 35%, Weight
gain– 34%, Sedation – 27%,
20%
paliperidone (n=5)
olanzapine (n=103)
aripiprazole (n=105)
All typicals (n=91)
Weight gain – 36%, Sedation –
29%, Metabolic side effects
(excluding weight gain) – 13%
Weight gain – 18%, Sedation –
16%, Akathisia – 12%
Sedation – 25%, Weight gain –
19%, Extrapyramidal side effects
(including tardive dyskinesia) (not
including akathisia – 18%
Source: Patient record form, prescription level
Base: oral prescriptions (n=518), LAIs prescriptions (n=311)
% No side
effects
39%
60%
39%
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 adherence and insight
Treatment landscape
• Overall prescribing, reasons for prescribing and switching
• Exploration around LAI treatments
68
68
PRF
Around 2/3 of patients on Risperdal Consta were previously on the oral formulation
of the same drug. Almost half of patients receiving paliperidone palmitate 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
11%
9%
% of patients
12%
Another LAIs treatment
8%
9%
5%
9%
7%
13%
11%
8%
12%
18%
5%
9%
5%
20%
18%
10%
22%
17%
22%
22%
44%
64%
64%
46%
Risperidone (n=19)
Olanzapine (n=8)
51%
32%
20%
All LAIs (n=242)
Atypical LAIs
(n=184)
Risperdal Consta
(n=107)
Source: Patient record forms. Base: currently receiving LAI (n=242)
Paliperidone
palmitate (n=55)
Olanzapine
Typical LAIs (n=60)
Pamoate (n=22)
CAUTION: Low bases (<n=30)
69
PRF
For almost half of all patients, satisfaction with adherence to oral
therapy is the main reason why patients are not on an LAI. Patient
unwillingness is also stated as the reason for over 1/3 of patients
B28 Why is the patient not currently on a LAI formulation treatment?
45%
Satisfactory adherence with oral therapy
37%
Patient unwillingness
35%
% of patients
Satisfactory treatment response to oral therapy
17%
I never offered a depot formulation to the patient
14%
The right drug is not available as a depot formulation
Family unwillingness
4%
Cost/reimbursement
4%
Practical reason e.g. not being able to attend hospital for
injection
3%
Patient current condition/symptoms
3%
Unsure how to approach injections with the patient
3%
Formulary restrictions
Low experience / familiarity with depot treatment
1%
0%
Source: Patient record forms. Base: not currently receiving LAI (n=327)
70
InforMed Insight are members of the following market research professional bodies
and abide by their codes of practice:
71