24th European congress of Psychiatry EPA 2016, Madrid, Spain, 12-15 March 2016

Effective doses of Paliperidone palmitate (PAP): retrospective

analysis from three years of treatment
Galiano Rus S; Soler Iborte A; Quesada Gonzlez C.
Unidad de Gestin Clnica de Salud Mental Jan Norte.

Introduction

Objectives

The use of atypical, prolonged-release anti-psychotics is already

much extended in general, and even more so in our area of
healthcare. There is no clear consensus about the most effective
average dose, including the dose range with which we can achieve
the best results. The recommended doses in the technical
specifications of the drugs, as the result of trial studies, differ from the
doses administered in habitual clinical practice.
Therefore, the justification of this study is to monitor the average
doses prescribed, to be able to reach an agreement on the best
doses.

To retrospectively analyze the first 32 patients in our

area of healthcare who were prescribed PAP, the doses
used at the start of treatment and after 3 years.
As secondary objectives, to evaluate data related to the
continuation of the treatment, causes of abandonment of
treatment, possible associated oral APS treatment and
re-hospitalization rates of these patients, to be able to
compare them with results obtained with other injectable
APS or oral APS treatments.

Materials and Methods

PAP Doses

Two initial doses of PAP were analyzed, maximum and current

(outpatient) in 32 patients (24 men and 8 women) attended in the area
of mental health at the Unit of Clinical Management (UCM) of JanNorte, who started the treatment with PAP between 2012 and 2013,
with an average length of time of 2.55 years (SD 2.02). We evaluated
the diagnosis (schizophrenia and related disorders, ICD 10 F2), the
number of hospital admissions previous and posterior to the start of
the treatment and change in weight.
The average age was 44.7 years old (SD 11.6).
The treatment began at the outpatient level, or starting with an
admission into the hospital unit.
Data was obtained through a review of clinical history and direct
contact with each patients Community Mental Health Unit.

Results

DINI

DMAX

DACT
20
15
10
5

DACT
DINI

0
75mg 100mg 150mg 175mg 200mg 250mg

Changes in weight

Average doses: Initial: 110.15 mg (SD 32.83), maximum: 165.51 mg

(SD 29.76) and maintenance: 146.81 mg (SD 29.59).
Average hospital admissions: prior and posterior to the start of
treatment: 1.5 and 0.83. An average reduction of 44.06% in
admissions was observed.
Weight: 62.36% of the patients had a decrease in weight, with an
average of 10.2 Kg (SD 8.27). 29.41% had a maximum increase of 5
Kg and 8.23% had an increase greater than 5 Kg.
Others: 43.9% took oral antipsychotics (paliperidone or olanzapine,
21.74%; quetiapine, 26%; and clozapine, 0.26%). The rest were
under monotherapy, either taking or not other psychiatric drugs.
54.17% of the patient had been previously treated with an
antipsychotic drug. The ones that had received it had taken
fluphenazine (27.08%), risperidone (16.67%) and zuclopenthixol
(6.25%). Two abandonments were observed (0.003%) and one
optional interruption of the treatment.

Inc < 5 kg
Inc > 5 kg
Dec.

AP vs oral

Conclusions
The data obtained suggests that a dose of 75-200mg could be
effective in the maintenance of patients with schizophrenia and for
decreasing the number of new hospital admissions. 50% of the cases
can be compensated with long-acting peliperidone as a monotherapy.
The low rate of abandonments and interruptions of the treatment
suggests that the drug was tolerably accepted.
Bibliography
Nasrallah HA, et al. A controlled, evidence-based trial of paliperidone palmitate, a long-acting injectable antipsychotic, in schizophrenia. Neuropsychopharmacology 2010; 35: 2072-28082
Kramer M, et al. Efficacy and safety of paliperidone palmitate in adul patients with acutely symptomatic schizophrenia: a randomized,double-blind,placebo-controlled, efficacy and safety study. Int J Neuropsychopharmacol 2010;13:: 635-647

NO APO
1 APO