Paliperidone Palmitate Intramuscular 3-Monthly Formulation: A Review in Schizophrenia

A 3-monthly formulation of intramuscular paliperidone palmitate (3-monthly paliperidone palmitate) has recently been approved for the maintenance treatment of schizophrenia in adult patients in the EU (Trevicta^®), following earlier approval in the USA (Invega Trinza^®). This narrative review discusses the clinical use of 3-monthly paliperidone palmitate in the maintenance treatment of schizophrenia in adult patients and summarizes its pharmacological properties. The efficacy of the 3-monthly paliperidone palmitate formulation as a maintenance treatment for schizophrenia has been demonstrated in well designed, phase III trials. Three-monthly paliperidone palmitate was more effective than placebo in delaying time to relapse and reducing relapse rates, and was noninferior to 1-monthly paliperidone palmitate in the proportion of patients that remained relapse-free. The 3-monthly formulation was also more effective than placebo in controlling the symptoms of schizophrenia, whilst not differing significantly from the 1-monthly formulation in terms of symptomatic control. Three-monthly paliperidone palmitate was generally well tolerated in clinical trials, with a tolerability profile consistent with that of the 1-monthly formulation. In conclusion, 3-monthly paliperidone palmitate is a useful treatment option for adult patients with schizophrenia who are adequately treated with the 1-monthly formulation, particularly for those who would prefer, or may benefit from, longer dosing intervals.