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SAN DIEGO -- Among patients with schizophrenia, most preferred long-acting injectable antipsychotics when given a choice, a researcher reported here.

A post-hoc analysis of a randomized, controlled study found 77% of the 1,402 participants surveyed preferred long-acting injectable (LAI) antipsychotics over daily pills, according to a poster presented by Clifton Blackwood, MD, of Pennsylvania State University in Centre County, at Psych Congress 2019.

Blackwood's group administered a Medication Preference Questionnaire to participants with schizophrenia in a comparing the atypical antipsychotic paliperidone palmitate 3-month (Invega Trinza) versus paliperidone palmitate 1-month (Invega Sustenna). Of note, this 3-month injectable is indicated for patients who have been adequately treated with the 1-month injectable for a minimum of 4 months. The questionnaire was administered at baseline.

When asked about how goals and outcomes played a role in therapy preference, more than half of patients who said they preferred injectables cited greater patient empowerment as one of the reasons for this preference. Specifically, 57% said they "feel more healthy" with injectables, while 52% and 47% said they "feel like myself again" and that they feel more in control of the medicine they take, respectively.

Quality of life and treatment adherence were also major factors leading to patients opting for long-acting injections. Roughly half of patients who preferred injectables cited the following as important reasons for this preference:

• Can get back to favorite activities
• Don't have to think about taking medicine
• Fewer side effects
• Makes symptoms go away
• Feel less confused
• Feel symptoms will not come back

When patients were asked preferences solely based upon their own personal experiences, they reported similar reasons for their preference. More than two-thirds of respondents said they preferred long-acting injectables because they are "easier" and they also feel "more in control," due to the fact they don't have to think about taking a daily oral medication.

Although not by as wide of a margin, more respondents who preferred long-acting injections versus pills also cited fewer side effects (37% vs 10%), better efficacy for symptom control (37% vs 8%), and less pain/sudden symptoms (38% vs 18%) as other reasons for their preference. However, around half of those who preferred pills said feeling "less embarrassed" was a reason for this preference.

In regards to demographic factors, white individuals were over two times more likely to prefer a long-achieving injectable compared with other races (adjusted odds ratio 2.44, 95% CI 1.80-3.30). However, people from the U.S. were significantly less likely to prefer an injectable, and instead preferred pills (OR 0.43, 95% CI 0.28-0.65). "Findings from the USA were mainly driven by the African-America population (54.3%)," the researchers pointed out. Other factors, including age, BMI, sex, and prior psychiatric hospitalization were not tied to medication preference.

When asked about preference for the frequency of treatment administration, the vast majority preferred every 3-months, which was the least frequent administration available. In comparison, only 3% said they preferred a daily medication, while 9% didn't have any preference for frequency.

Reasons for preferring a 3-month injectable option were fairly obvious: 96% said they simply liked having fewer injections. Other reasons behind this preference were fewer doctor visits, fewer problems with transportation to get to appointments, less pain associated with fewer injectables, and also fewer conflicts and interactions with other medications.

However, among those who preferred the 1-month injectable, the main reason cited for this preference was the ability for dosage to be changed. These people also noted they like seeing their doctor more often, were accustomed to monthly injectables, and did not like taking too much medication at once.

When asked about preference of injection site, patients only moderately tended to prefer deltoid versus gluteal injections. Reasons behind this preference of injection site included ease of injection, feeling less embarrassed, and fast injection.

Healthcare providers should take into consideration patient preference when developing the treatment plan, the authors recommended. "Better understanding of patient's treatment priorities and perspective could help overcome barriers to LAI use and inform best course of personalized schizophrenia treatment for improved patient satisfaction and medication adherence," they concluded.

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