OBJECTIVES: Schizophrenia is affecting 0.56% of the Japanese population. The estimated annual burden of disease exceeds 3.5 million yen per patient (approximately US$30,000). Prescribing patterns are complex and characterised by treatment switching, discontinuation, relapse and poor adherence to antipsychotic medication. This study aims to improve the knowledge in real world the schizophrenia treatment patterns based on Japan retrospective claims.

METHODS: Patients were selected from JMDC claims, an employment-based administrative database containing the medical and pharmacy claims from ten different payers between 2009 and 2013 with at least one antipsychotic drug. A TAK method was applied in 3 steps. A vector analysis of each patient and the treatment pattern to cluster patient treatment based on a similarity score was applied. The second step was to rank the treatment pattern based on “Hierarchical Agglomerative Clustering” algorithm. Finally, an image processing technique was applied to eliminate noise and improve Interpretability.

RESULTS: Amon 12,066 patients, 40 different treatments were prescribed in total, the mean (SD) age was 35 (14) years and mean (SD) follow-up duration was 1.9 (1.2) years. Among 24 most frequently used treatments, Sulpiride was the most frequent first line treatment (50.8% of patients). Sulpiride patients profile presented a low persistence characterised by a Median(Q1, Q3) time to discontinuation of 82(27, 217) days. In subsequent lines, Sulpiride was prescribed in combination with Olanzapine. Risperidone was the second most frequent first line treatment (9.6% of patients). Patients initiating Risperidone presented a Median(Q1, Q3) time to discontinuation of 84(25, 238) days. In subsequent lines, switching to Levomepromazine Maleate was observed.

CONCLUSIONS: This analysis confirms low persistence and frequent switching between antipsychotics in patients with schizophrenia. The AI method support a better Real World Evidence understanding of antipsychotic treatment sequences in schizophrenic patients.