Lilly USA, LLC, Indianapolis, Indiana, USA.
BMC Psychiatry. 2011 Jan 31;11:19. doi: 10.1186/1471-244X-11-19.
Duloxetine and venlafaxine extended release (venlafaxine XR) are SNRIs indicated for the treatment of MDD. This study addresses whether duloxetine and venlafaxine XR are interchangeable in their patterns of use with patients who are depressed or are used more selectively based on treatment history, background characteristics, and presenting symptoms.
This was a retrospective analysis of an administrative insurance claims database. We studied patients in managed care with major depressive disorder (MDD) treated with duloxetine or venlafaxine XR. Predictors of treatment and cost were assessed using Chi-square and logistic regression analyses of demographics and past-year medication use and comorbidities.
Patients with MDD treated with duloxetine (n = 9,641) versus venlafaxine XR (n = 8,514) tended to be older, slightly more likely to be female, and treated by a psychiatrist (P < 0.0001). In the prior year, more duloxetine patients (vs. venlafaxine XR) received ≥ 3 unique antidepressants (20.8% vs. 16.6%), ≥ 3 unique pain medications (25.5% vs. 15.6%), and had ≥ 8 unique diagnosed comorbid medical and psychiatric conditions (38.6% vs. 29.1%). The prior 6-month total health care costs were $1,731 higher for duloxetine than for venlafaxine XR and declined for both medications in the 6 months after treatment began. Logistic regression analysis revealed that 61% of duloxetine patients and 61% of venlafaxine XR patients were predictable from prior patient and treatment factors.
Patients with MDD treated with duloxetine tended to have a more complex and costly antecedent clinical presentation compared with venlafaxine XR patients, suggesting that physicians do not use the medications interchangeably.
度洛西汀和文拉法辛缓释剂（venlafaxine XR）均为 SNRIs，适用于治疗 MDD。本研究旨在探讨度洛西汀和文拉法辛 XR 在使用模式上是否可以相互替代，即在治疗抑郁患者时是否更具选择性，还是基于治疗史、背景特征和现有症状。
这是一项对管理式医疗保健保险理赔数据库的回顾性分析。我们研究了接受度洛西汀或文拉法辛 XR 治疗的患有重度抑郁症（MDD）的患者。使用卡方检验和逻辑回归分析评估人口统计学和过去一年用药情况及合并症等因素对治疗和费用的预测作用。
与接受文拉法辛 XR 治疗的患者（n=8514）相比，接受度洛西汀治疗的 MDD 患者（n=9641）年龄更大，女性略多，且由精神科医生治疗（P<0.0001）。在过去一年中，与文拉法辛 XR 组相比，更多的度洛西汀患者（20.8% vs. 16.6%）接受了≥3 种不同的抗抑郁药，≥3 种不同的止痛药物（25.5% vs. 15.6%），以及≥8 种不同的诊断出的合并症（38.6% vs. 29.1%）。度洛西汀组在治疗前 6 个月的总医疗保健费用比文拉法辛 XR 组高 1731 美元，且两种药物在治疗开始后的 6 个月内都有所下降。逻辑回归分析显示，61%的度洛西汀患者和 61%的文拉法辛 XR 患者可以根据既往患者和治疗因素进行预测。
与文拉法辛 XR 患者相比，接受度洛西汀治疗的 MDD 患者的临床前表现更为复杂，费用也更高，这表明医生并未将这两种药物相互替代使用。
