Liu Xianchen, Chen Yi, Faries Douglas E
Former employee, Eli Lilly and Company, Indianapolis, Indiana, USA;
Clinicoecon Outcomes Res. 2011;3:63-72. doi: 10.2147/CEOR.S17846. Epub 2011 Mar 15.
THIS STUDY COMPARED ADHERENCE AND PERSISTENCE OF THREE BRANDED ANTIDEPRESSANTS: the serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine and venlafaxine XR, and the selective serotonin reuptake inhibitor (SSRI) escitalopram; and generic selective SSRIs, and examined demographic and clinical predictors of adherence and persistence in patients with major depressive disorder in usual care settings.
A total of 44,026 patients (18 to 64 years) from a large commercial administrative claims database were classified as initiators of duloxetine (n = 7,567), venlafaxine XR (n = 6,106), escitalopram (n = 10,239), or generic SSRIs (n = 20,114) during 2006. Adherence was defined as the medication possession ratio of ≥0.8 and persistence as the length of therapy without exceeding a 15-day gap. Pairwise comparisons from multivariate logistic regression and Cox proportional hazards models were performed to examine predictors of adherence and persistence.
Adherence rate after one year was significantly higher in duloxetine recipients (38.1%) than patients treated with venlafaxine XR (34.0%), escitalopram (25.4%), or generic SSRIs (25.5%) (all P < 0.01). Duloxetine recipients stayed on medication longer (158.5 days) than those receiving venlafaxine XR (149.6 days), escitalopram (129.1 days), or generic SSRIs (130.2 days) (all P < 0.001). Compared with patients treated with escitalopram or generic SSRIs, venlafaxine XR recipients had better adherence and longer persistence (P < 0.001). In addition, being aged 36 years or more, hypersomnia, anxiety disorders, and prior use of antidepressants were associated with increased adherence and persistence, while the opposite was true for comorbid chronic pain conditions, alcohol and drug dependence, and prior use of amphetamine.
Compared with SSRIs, the SNRIs appear to have better adherence and persistence. Among SNRIs, duloxetine had statistically significantly better adherence and persistence than venlafaxine XR, though differences were relatively small and further research is needed to assess whether these translate into clinically and economically meaningful outcomes. Adherence and persistence with antidepressant therapy were associated with age, multiple comorbid conditions, and prior use of medications.
本研究比较了三种品牌抗抑郁药的依从性和持续性，这三种药物分别为：5-羟色胺与去甲肾上腺素再摄取抑制剂（SNRIs）度洛西汀和文拉法辛缓释剂，以及选择性5-羟色胺再摄取抑制剂（SSRI）艾司西酞普兰；同时还比较了通用型选择性SSRI，并研究了在常规护理环境下重度抑郁症患者依从性和持续性的人口统计学及临床预测因素。
从一个大型商业管理索赔数据库中选取了44026名年龄在18至64岁之间的患者，将其分类为2006年期间度洛西汀（n = 7567）、文拉法辛缓释剂（n = 6106）、艾司西酞普兰（n = 10239）或通用型SSRI（n = 20114）的初始使用者。依从性定义为药物持有率≥0.8，持续性定义为治疗时长且无超过15天的间断。通过多变量逻辑回归和Cox比例风险模型进行成对比较，以研究依从性和持续性的预测因素。
度洛西汀使用者一年后的依从率（38.1%）显著高于接受文拉法辛缓释剂（34.0%）、艾司西酞普兰（25.4%）或通用型SSRI（25.5%）治疗的患者（所有P < 0.01）。度洛西汀使用者的用药持续时间（158.5天）长于接受文拉法辛缓释剂（149.6天）、艾司西酞普兰（129.1天）或通用型SSRI（130.2天）治疗的患者（所有P < 0.001）。与接受艾司西酞普兰或通用型SSRI治疗的患者相比，文拉法辛缓释剂使用者具有更好的依从性和更长的持续性（P < 0.001）。此外，年龄36岁及以上、嗜睡、焦虑症以及既往使用过抗抑郁药与依从性和持续性增加相关，而合并慢性疼痛状况、酒精和药物依赖以及既往使用过苯丙胺则情况相反。
与SSRI相比，SNRI似乎具有更好的依从性和持续性。在SNRI中，度洛西汀在统计学上的依从性和持续性显著优于文拉法辛缓释剂，尽管差异相对较小，还需要进一步研究来评估这些差异是否转化为具有临床和经济意义的结果。抗抑郁治疗的依从性和持续性与年龄、多种合并症以及既往用药情况有关。
