Efficacy of Paliperidone in Patients Who Are Encountering Their First Episode of Schizophrenia

Abstract

Background: Early, effective treatment during the first episode of schizophrenia can reduce symptomatic burden and improve trajectories, yet real-world evidence using the Brief Psychiatric Rating Scale (BPRS) for oral paliperidone extended-release (ER) in routine settings remains limited. Objective: To determine the 12-week symptomatic efficacy of oral paliperidone ER in first-episode schizophrenia. Methods: This prospective, single-arm before–after study enrolled consecutive outpatients aged 18–60 years with first-episode schizophrenia at two public hospitals in Pakistan (1 February–30 December 2024). Participants initiated paliperidone ER 3 mg once daily, titrated to a maximum of 12 mg once daily as clinically indicated. BPRS was assessed at baseline and 12 weeks; the primary outcome was changed in BPRS. The predefined responder endpoint was ≥40% BPRS reduction at 12 weeks. Analyses (SPSS v26) included paired t-tests, Wilson 95% CIs for responder proportion, chi-square tests and effect sizes across age, sex, education, and socioeconomic strata, with exploratory logistic regression. Results: Among 160 participants, mean BPRS decreased from 52.63±6.54 to 33.15±12.46 (mean change −19.48; ≈37% relative; p<0.001). The responder rate was 58.1% (93/160; 95% CI 50.4–65.5). Responder proportions did not differ by age, sex, education, or socioeconomic status (all p>0.05; effect sizes near null). Conclusion: Oral paliperidone ER produced clinically meaningful 12-week symptom reductions in first-episode schizophrenia with consistent efficacy across demographic subgroups, supporting its use as a dependable first-line option in routine early-intervention care and motivating longer-term, controlled studies with systematic safety and functional outcomes.