Discontinuation of Perseris
In July 2024, Indivior, the company behind the once-monthly injectable medication Perseris, made the significant announcement that it would be discontinuing all sales and marketing for the product. This decision was driven by business factors, citing increased payor management pressures and a highly competitive market, which rendered the drug financially unviable. Importantly, the manufacturer emphasized that this action was not related to any safety or efficacy concerns with the medication itself.
To ensure continuity of care and minimize disruption for existing patients, Indivior committed to continuing the supply of Perseris for a transitional period. This initial transition period was planned to last a minimum of one year from the announcement. However, as the supply is finite and the medication is no longer being actively promoted, patients and healthcare providers must work together to transition to alternative treatments for schizophrenia.
The Impact on Current Patients
For individuals whose treatment plan involves Perseris, this development necessitates a careful and timely discussion with their doctor. Patients should not stop their medication abruptly, as this can lead to a return of schizophrenia symptoms. The transition plan will involve a healthcare provider assessing the patient's condition and determining the most appropriate next steps, which may include switching to another form of risperidone or a different antipsychotic medication altogether.
Comparison of Long-Acting Risperidone Injections
Perseris was one of several long-acting injectable (LAI) versions of risperidone available on the market. Understanding the differences between these formulations and other options is key for planning a transition. The primary distinction among risperidone LAIs lies in their administration frequency and injection site.
| Feature | Perseris (discontinued) | Risperdal Consta | Uzedy | Rykindo |
|---|---|---|---|---|
| Risperidone LAI Type | Subcutaneous depot | Microsphere in intramuscular injection | Subcutaneous depot | Microsphere in intramuscular injection |
| Administration Frequency | Once monthly | Every 2 weeks | Once every 1 to 2 months | Every 2 weeks |
| Injection Site | Subcutaneous (upper arm or abdomen) | Intramuscular (gluteal or deltoid muscle) | Subcutaneous (upper arm or abdomen) | Intramuscular (gluteal muscle) |
| Oral Supplementation | Not required with initiation | Required for the first 3 weeks | Not required with initiation | Required for the first 3 weeks |
Alternative Treatments and Considerations
When a medication is discontinued, healthcare providers and patients must explore suitable alternatives. For those on Perseris, several options exist within the class of atypical antipsychotics.
Other Risperidone Long-Acting Injectables
As detailed in the comparison table, other LAIs with the active ingredient risperidone are available. The subcutaneous depot injection Uzedy offers an alternative with a similar injection method to Perseris, but with a less frequent (every 1 to 2 months) administration schedule. The intramuscular injections Risperdal Consta and Rykindo, while requiring a higher frequency (every 2 weeks) and initial oral supplementation, are also viable options.
Other Atypical Antipsychotic LAIs
There are numerous other second-generation (atypical) antipsychotics that come in long-acting injectable forms. These alternatives have different active ingredients and may be suitable depending on a patient's individual needs, side effect profile, and response to treatment. Some examples include:
- Paliperidone injections: These are derivatives of risperidone and include Invega Sustenna (monthly), Invega Trinza (quarterly), and Invega Hafyera (semi-annually).
- Aripiprazole injections: This includes Abilify Maintena (monthly) and Aristada (monthly, every 6 weeks, or every 8 weeks).
- Olanzapine injections: Zyprexa Relprevv is another injectable option, though it carries a risk of post-injection delirium sedation syndrome.
Oral Medications
For some patients, a return to daily oral medication may be appropriate. Risperidone is available in generic oral formulations, and many other oral atypical antipsychotics exist. This can be a short-term solution while exploring other long-acting injections or a long-term plan, depending on adherence and clinical stability.
The Patient's Next Steps
- Schedule an appointment with your healthcare provider. This is the most important step. Patients should not wait until their next scheduled injection to discuss the change. Bring questions and concerns to the meeting.
- Do not stop treatment abruptly. It is critical to continue with your current Perseris injections for as long as they are available, or as your doctor directs, to avoid a relapse in symptoms.
- Review alternatives with your doctor. Discuss the different long-acting injectable options and oral medications that are available. Consider factors like injection frequency, site, and potential side effects.
- Involve your support system. Family members or caregivers can play a vital role in the transition process, helping to monitor for any changes in mood or behavior. The National Alliance on Mental Illness (NAMI) is an excellent resource for patient and family education.
Conclusion
The discontinuation of Perseris by its manufacturer, Indivior, was a business decision made in July 2024, not a result of any product safety issues. While the company intended to supply the medication for at least a year to minimize patient disruption, it is no longer actively marketed, and its long-term availability is not assured. Patients on Perseris must consult their healthcare providers to develop a transition plan to alternative long-acting injectable or oral formulations of risperidone or other appropriate antipsychotics. This proactive approach is essential for maintaining treatment efficacy and preventing a relapse of schizophrenia symptoms.
