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REAL-WORLD PERSISTENCE ON OLANZAPINE/SAMIDORPHAN VERSUS OTHER ORAL SECOND-GENERATION ANTIPSYCHOTICS IN PATIENTS WITH SCHIZOPHRENIA

Andrew J. Cutler — MD1, Christoph U. Correll, MD2, Rakesh Jain, MD, MPH3, Craig Chepke, MD4, Hara E. Oyedeji, DNP, PMHNP-BC5, Alejandro G. Hughes, MPH6, Noah S. Webb, PhD6, Michael J. Doane, PhD7, Hemangi R. Panchmatia, MSc7 1SUNY Upstate Medical University, Neuroscience Education Institute, 2Zucker Hillside Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, Charité Universitätsmedizin Berlin, German Center for Mental Health (DZPG),3Texas Tech University School of Medicine-Permian Basin, 4Excel Psychiatric Associates, P.A., 5Fortitude Behavioral Health, 6Optum, Inc., 7Alkermes, Inc.

2026 ASCP Annual Meeting

Background

Poor persistence and adherence to oral antipsychotic medications are common in clinical practice and are associated with increased relapse risk. Treatment continuity may indicate that a medication has an acceptable balance of symptom relief and tolerability over time for a given individual. Prior real-world studies showed that initiating a combination of olanzapine and samidorphan (OLZ/SAM) vs olanzapine in adults with schizophrenia or bipolar I disorder is associated with greater adherence, longer treatment persistence, and fewer diseaserelated hospitalizations and emergency department visits (proxies for psychiatric relapse). This study evaluated real-world persistence and adherence with OLZ/SAM compared with other oral second-generation antipsychotic (SGA) medications among patients with schizophrenia.

Methods

This retrospective claims analysis used Komodo Healthcare Map data (10/18/2020– 12/31/2024). Data from Medicaid-insured adults with schizophrenia and ≥1 claim for OLZ/SAM or a comparator SGA (aripiprazole, brexpiprazole, cariprazine, lumateperone, lurasidone, olanzapine, or risperidone) were included. OLZ/SAM claims were prioritized to set the index date. Inverse probability treatment weighting (IPTW) was used to balance cohorts on key demographic/clinical variables. Proportions of patients persisting on the same medication as on the index date for the full study period, durations of persistence (days from index date to discontinuation date [using a ≥45-day gap to define treatment discontinuation] or to end of follow up), and adherence (medication possession ratio [MPR] ≥0.80) were compared among the OLZ/SAM and comparator oral SGA cohorts during the 12-month follow-up period. P values ≤0.05 were considered statistically significant.

Results

A total of 45,566 patients with schizophrenia were included (OLZ/SAM, n=1244; aripiprazole, n=11,995; brexpiprazole, n=421; cariprazine, n=1650; lumateperone, n=423; lurasidone, n=2030; olanzapine, n=14,630; risperidone, n=13,173). Comparisons to brexpiprazole and lumateperone were not assessed due to low numbers of patients treated with these medications. In IPTW-adjusted analyses, patients initiating OLZ/SAM vs other oral SGAs were significantly more likely to remain on treatment at 12 months (odds ratio [OR] range, 1.57– 2.71; all P < 0.001). Mean duration of treatment persistence was significantly longer with OLZ/SAM (201.8±143.6 days) vs all comparators (range, 132.1±129.5 – 174.1±138.8 days; all P < 0.001). At least 50% of OLZ/SAM patients remained on treatment for 180 days or longer vs a median duration of 67 to 121 days for comparator oral SGAs. Patients initiating OLZ/SAM vs comparator oral SGAs were also twice as likely to be adherent (MPR ≥ 0.80 OR range, 1.33– 2.53; all P < 0.001).

Conclusion

OLZ/SAM was associated with a statistically significantly higher proportion of patients persistent on treatment, longer duration of persistence, and greater adherence during 12month follow-up vs all comparator oral SGAs. More consistent antipsychotic medication use over time may translate into meaningful improvements in outcomes associated with schizophrenia. This study was funded by Alkermes, Inc. Medical writing and editorial support were provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Alkermes, Inc.