Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data
Abstract Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-01-01
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| Series: | Epidemiology and Psychiatric Sciences |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2045796023000732/type/journal_article |
| _version_ | 1797681921562509312 |
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| author | Edouard-Jules Laforgue Marion Istvan Anicet Chaslerie Pascal Artarit Geneviève Vallot Pascale Jolliet Marie Grall-Bronnec Caroline Victorri-Vigneau |
| author_facet | Edouard-Jules Laforgue Marion Istvan Anicet Chaslerie Pascal Artarit Geneviève Vallot Pascale Jolliet Marie Grall-Bronnec Caroline Victorri-Vigneau |
| author_sort | Edouard-Jules Laforgue |
| collection | DOAJ |
| description | Abstract
Aims
Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories.
Methods
Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis.
Results
The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations.
Conclusions
The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.
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| first_indexed | 2024-03-11T23:52:01Z |
| format | Article |
| id | doaj.art-45c33a87ea8a4982922732cdfc5c96c5 |
| institution | Directory Open Access Journal |
| issn | 2045-7960 2045-7979 |
| language | English |
| last_indexed | 2024-03-11T23:52:01Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Epidemiology and Psychiatric Sciences |
| spelling | doaj.art-45c33a87ea8a4982922732cdfc5c96c52023-09-19T06:37:41ZengCambridge University PressEpidemiology and Psychiatric Sciences2045-79602045-79792023-01-013210.1017/S2045796023000732Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance dataEdouard-Jules Laforgue0https://orcid.org/0000-0002-7400-1212Marion Istvan1https://orcid.org/0000-0001-7386-3075Anicet Chaslerie2https://orcid.org/0000-0002-9144-2239Pascal Artarit3Geneviève Vallot4Pascale Jolliet5https://orcid.org/0000-0003-0191-9249Marie Grall-Bronnec6https://orcid.org/0000-0003-0722-7243Caroline Victorri-Vigneau7https://orcid.org/0000-0002-3745-2532CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, FranceCHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, FranceMedical Department, Regional Health Insurance Pays de la Loire, Nantes, FranceMedical Department, Regional Health Insurance Pays de la Loire, Nantes, FranceMedical Department, Regional Health Insurance Pays de la Loire, Nantes, FranceCHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, FranceCHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, FranceCHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, FranceAbstract Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription. https://www.cambridge.org/core/product/identifier/S2045796023000732/type/journal_articleantipsychoticsclozapinepharmacoepidemiologystate sequence analysis |
| spellingShingle | Edouard-Jules Laforgue Marion Istvan Anicet Chaslerie Pascal Artarit Geneviève Vallot Pascale Jolliet Marie Grall-Bronnec Caroline Victorri-Vigneau Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data Epidemiology and Psychiatric Sciences antipsychotics clozapine pharmacoepidemiology state sequence analysis |
| title | Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data |
| title_full | Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data |
| title_fullStr | Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data |
| title_full_unstemmed | Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data |
| title_short | Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data |
| title_sort | characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia an innovative visualization of trajectories using french national health insurance data |
| topic | antipsychotics clozapine pharmacoepidemiology state sequence analysis |
| url | https://www.cambridge.org/core/product/identifier/S2045796023000732/type/journal_article |
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