A Claims Data-Based Comparison of Treatment Continuation between Aripiprazole Once-monthly and Paliperidone Palmitate in Routine Practice.

Objective: Aripiprazole once-monthly (AOM) and paliperidone palmitate once-monthly (PP1M) are commonly used long-acting injectable APs (LAIs) in routine practice. However, their distinct pharmacological properties may differentially influence on long-term treatment continuation. To date, comparison data on long-term treatment continuation between AOM and PP1M are limited. Methods: Patients with schizophrenia spectrum disorders identified from the Korean Health Insurance Review and Assessment Service claims database were followed for 12 months after initiating AOM or PP1M. Cox proportional hazards and Kaplan-Meier analyses were used to assess discontinuation risk and rates. Results: There were significant differences in the discontinuation risk and rates at 6 months (HR = 1.301, 95% CI = 1.242-1.363 and 45.5% vs. 56.2%, respectively) and 12 months (HR = 1.322, 95% CI = 1.270-1.376 and 62.7% vs. 74.1%, respectively) between the two LAIs, where the patients treated with AOM showed lower discontinuation rates than those treated with PP1M. The all-cause hospitalization rates (52.3% vs 60.4%; 53.7% vs 61.6%) and newly developed extrapyramidal symptoms (6.2% vs 7.0%; 7.7% vs. 8.1%) at 6 months and 12 months were numerically lower in AOM than in PP1M, respectively. These findings were consistent in PSM and 3-month landmark analysis. Conclusion: In this nationwide real-world study, AOM was associated with a lower risk of treatment discontinuation than PP1M over 12 months. These findings suggest differences in treatment continuation between the two LAIs and warrant confirmation in studies using more robust designs and diverse clinical data.