Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response

Jean Pierre Lindenmayer, Hong Liu-Seifert, Pandurang M. Kulkarni, Bruce J. Kinon, Virginia Stauffer, Sara E. Edwards, Lei Chen, David H. Adams, Haya Ascher-Svanum, Peter F Buckley, Leslie Citrome, Jan Volavka

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Abstract

Objective: To examine the impact of medication nonadherence on treatment outcome in schizophrenia and potential risk factors for nonadherence. Method: A post hoc analysis of a randomized, double-blind, 8-week, fixed-dose study comparing olanzapine 10, 20, and 40 mg/day for patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) with suboptimal response to current treatment (N = 599) was conducted between September 12, 2003, and November 3, 2005, at 55 study centers in the United States. Nonadherence was defined as not taking medication as prescribed based on daily pill counts. Because there was no significant difference in nonadherence between dose groups, effects of nonadherence on efficacy and safety outcomes were examined using all 3 groups combined. Baseline demographics and symptom severity were investigated as potential risk factors for nonadherence. Results: During the 8-week study, 34.5% of patients were nonadherent at least once. Nonadherent patients had significantly less improvement compared to adherent patients as measured by change in Positive and Negative Syndrome Scale total score (-22.57 vs. -26.84, p = .002). Longer duration of nonadherence was associated with reduced likelihood of treatment response (odds ratio = 0.94, 95% CI = 0.90 to 0.99, p = .008). The early treatment discontinuation rate was higher in nonadherent compared to adherent patients (40.8% vs. 24.5%, p < .001). Adherent and nonadherent patients had comparable outcomes in most safety measures, except for weight change, for which adherent patients had greater weight gain than nonadherent patients (2.63 kg vs. 1.96 kg, p = .02). Greater depression severity at baseline (p = .01) and greater hostility level during the study were significant risk factors for nonadherence (p = .02). Conclusions: Medication nonadherence had a significantly negative impact on treatment response, highlighting the importance of adherence to achieve satisfactory treatment outcome. Findings may also help clinicians identify patients at risk for nonadherence and utilize interventions to improve adherence. Trial Registration: clinicaltrials.gov Identifier: NCT00100776.

Original languageEnglish (US)
Pages (from-to)990-996
Number of pages7
JournalJournal of Clinical Psychiatry
Volume70
Issue number7
DOIs
StatePublished - Jul 1 2009

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Medication Adherence
Psychotic Disorders
Schizophrenia
olanzapine
Safety
Hostility
Therapeutics
Diagnostic and Statistical Manual of Mental Disorders
Weight Gain
Odds Ratio
Demography
Depression
Weights and Measures

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Lindenmayer, J. P., Liu-Seifert, H., Kulkarni, P. M., Kinon, B. J., Stauffer, V., Edwards, S. E., ... Volavka, J. (2009). Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. Journal of Clinical Psychiatry, 70(7), 990-996. https://doi.org/10.4088/JCP.08m04221

Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. / Lindenmayer, Jean Pierre; Liu-Seifert, Hong; Kulkarni, Pandurang M.; Kinon, Bruce J.; Stauffer, Virginia; Edwards, Sara E.; Chen, Lei; Adams, David H.; Ascher-Svanum, Haya; Buckley, Peter F; Citrome, Leslie; Volavka, Jan.

In: Journal of Clinical Psychiatry, Vol. 70, No. 7, 01.07.2009, p. 990-996.

Research output: Contribution to journalArticle

Lindenmayer, JP, Liu-Seifert, H, Kulkarni, PM, Kinon, BJ, Stauffer, V, Edwards, SE, Chen, L, Adams, DH, Ascher-Svanum, H, Buckley, PF, Citrome, L & Volavka, J 2009, 'Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response', Journal of Clinical Psychiatry, vol. 70, no. 7, pp. 990-996. https://doi.org/10.4088/JCP.08m04221
Lindenmayer, Jean Pierre ; Liu-Seifert, Hong ; Kulkarni, Pandurang M. ; Kinon, Bruce J. ; Stauffer, Virginia ; Edwards, Sara E. ; Chen, Lei ; Adams, David H. ; Ascher-Svanum, Haya ; Buckley, Peter F ; Citrome, Leslie ; Volavka, Jan. / Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. In: Journal of Clinical Psychiatry. 2009 ; Vol. 70, No. 7. pp. 990-996.
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AU - Kinon, Bruce J.

AU - Stauffer, Virginia

AU - Edwards, Sara E.

AU - Chen, Lei

AU - Adams, David H.

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N2 - Objective: To examine the impact of medication nonadherence on treatment outcome in schizophrenia and potential risk factors for nonadherence. Method: A post hoc analysis of a randomized, double-blind, 8-week, fixed-dose study comparing olanzapine 10, 20, and 40 mg/day for patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) with suboptimal response to current treatment (N = 599) was conducted between September 12, 2003, and November 3, 2005, at 55 study centers in the United States. Nonadherence was defined as not taking medication as prescribed based on daily pill counts. Because there was no significant difference in nonadherence between dose groups, effects of nonadherence on efficacy and safety outcomes were examined using all 3 groups combined. Baseline demographics and symptom severity were investigated as potential risk factors for nonadherence. Results: During the 8-week study, 34.5% of patients were nonadherent at least once. Nonadherent patients had significantly less improvement compared to adherent patients as measured by change in Positive and Negative Syndrome Scale total score (-22.57 vs. -26.84, p = .002). Longer duration of nonadherence was associated with reduced likelihood of treatment response (odds ratio = 0.94, 95% CI = 0.90 to 0.99, p = .008). The early treatment discontinuation rate was higher in nonadherent compared to adherent patients (40.8% vs. 24.5%, p < .001). Adherent and nonadherent patients had comparable outcomes in most safety measures, except for weight change, for which adherent patients had greater weight gain than nonadherent patients (2.63 kg vs. 1.96 kg, p = .02). Greater depression severity at baseline (p = .01) and greater hostility level during the study were significant risk factors for nonadherence (p = .02). Conclusions: Medication nonadherence had a significantly negative impact on treatment response, highlighting the importance of adherence to achieve satisfactory treatment outcome. Findings may also help clinicians identify patients at risk for nonadherence and utilize interventions to improve adherence. Trial Registration: clinicaltrials.gov Identifier: NCT00100776.

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