Risperidone Long-Acting Therapy Prescribing Patterns and Their Impact on Early Discontinuation of Treatment in a Large Medicaid Population

Objective: Medicaid claims were examined to determine whether utilization of risperidone long-acting therapy (LAT) was consistent with manufacturer’s prescribing information recommendations and what factors were associated with early discontinuation.

Method: Florida Medicaid claims between July 1, 2003, and June 30, 2007, were used. Recipient demographics and diagnoses, provision of oral antipsychotic supplementation during the first 21 days, number of injections received, medication possession ratio, and augmentation/polypharmacy after the first 21 days were assessed. Logistic regression was used to identify factors associated with early discontinuation of risperidone LAT.

Results: There were 3,364 individuals who received 4,546 episodes of risperidone LAT. Most recipients were between 18 and 64 years and had schizophrenia or schizoaffective disorder. Median episode length was 106 days. Median number of injections was 5. Supplementation with oral antipsychotic during the first 21 days was provided in 48% of episodes. Mean dosages were 25 mg or less for 28% of episodes and greater than 75 mg for 7% of episodes. Augmentation/polypharmacy after the first 21 days occurred in 43% of episodes. Early risperidone LAT discontinuation was associated with absence of oral supplementation during the first 21 days (P < .001), low (P = .045) or high (P < .001) initial doses of risperidone LAT, prior inpatient treatment (P < .001), having a substance use disorder (P = .001), and being male (P = .036).

Conclusions: Prescribing practices for risperidone LAT were compared with the recommended protocol. Risperidone LAT was typically used with recommended age and diagnostic groups. However, important discrepancies were identified that could have reduced perceived effectiveness and tolerability of risperidone LAT. Early discontinuation was less likely when the recommendations in the manufacturer’s prescribing information regarding dosage and supplementation with oral antipsychotics were followed.

J Clin Psychiatry 2011;72(8):1079-1085

Submitted: May 12, 2009; accepted December 1, 2009.

Online ahead of print: October 19, 2010 (doi:10.4088/JCP.09m05348yel).

Corresponding author: Timothy L. Boaz, PhD, University of South Florida, Department of Mental Health Law & Policy, 13301 Bruce B. Downs Blvd, Tampa, FL 33612-3899 (boaz@fmhi.usf.edu).