Prescriber- and Patient-Level Characteristics Associated with Patient Adherence to Any Antipsychotics Among Patients with Schizophrenia in the United States
Patient Preference and Adherence, 2026
Purpose
Antipsychotic (AP) medication adherence is important for the management of schizophrenia. This study thus aimed to evaluate prescriber- and patient-level characteristics and long-acting injectable (LAI) treatment use among patients with schizophrenia to determine the association between these factors and AP adherence.
Patients and methods
Adult patients with schizophrenia in the United States were identified from Komodo Research Data (01/01/2016-06/30/2023). Patients were required to have been initiated on an oral or LAI AP (index date) during the intake period (07/01/2021-06/30/2022), by a provider who prescribed APs to ≥6 patients with schizophrenia over the intake period (index prescriber). Providers were characterized using quartiles of the proportion of LAIs over all APs prescribed during the intake period (non-LAI prescribers; Q1: low, ≤8.5% LAIs; Q2-3: intermediate, >8.5% and <27% LAIs; Q4: high, ≥27% LAIs). Adherence to any AP (proportion of days covered ≥80%) was reported over the fixed 12-month follow-up period, and factors associated with adherence were evaluated using multivariate logistic regression.
Results
In total, 22,255 patients were included (mean age: 40.9; male: 66%; Medicaid: 76%). At index, 82% and 18% of patients were initiated on an oral AP or LAI, respectively, with 10%, 21%, 47%, and 22% of index APs prescribed by non-, low-, intermediate-, and high-LAI prescribers, respectively. Prescription of the index AP by an intermediate- or high- LAI prescriber was associated with 39% and 63% higher odds of adherence, respectively, relative to non-LAI prescribers (both p<0.001). Prescription of an LAI versus oral index AP was associated with 25% higher odds of adherence (p<0.001). Patients of all racial/ethnic minorities had lower odds of adherence relative to White patients (all p<0.050).
Conclusion
Adherence was higher among patients treated by high-LAI prescribers, indicating that familiarity with LAI treatment and awareness of adherence challenges may improve adherence rates among patients with schizophrenia.
Authors
Voegel A, Naranjo Jr RR, Diaz L, Eynde CV, Wang Y, Pilon D, Benson C, Citrome L