Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7573, USA.
Depress Anxiety. 2012 Jun;29(6):506-14. doi: 10.1002/da.21952. Epub 2012 May 2.
To evaluate the association between upward dose titration of antidepressants and medication adherence during the first 6 months of a newly initiated antidepressant treatment for patients with major depressive disorder (MDD).
We conducted a retrospective observational cohort study using Thomson Reuters MarketScan Commercial Claims and Encounters Claims data. We identified 40,873 patients aged 18-64 with MDD newly initiating a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or bupropion between July 1, 2005 and June 30, 2007. Patients with titration (defined as antidepressant initiation at doses equal or lesser than American Psychiatric Association treatment guidelines with a dosage increase in the first 60 days of treatment) were compared to patients with no titration. Adherence was measured as the proportion of days covered (PDC) on antidepressant treatment. Patients with PDC ≥ 80% were considered adherent. Persistence was measured as the duration of time from initiation to a 30-day gap in antidepressant treatment. Multivariate logistic regression and Cox-proportional hazard models examined the influence of titration on adherence and persistence, respectively.
Adherence was greater in the titration group than in the nontitration group (67.5% versus 45.2%, P < .01). After adjustment for selected covariates, patients in the titration group were more likely to adhere to antidepressant treatments (odds ratio = 2.60, 95% confidence interval (CI) = 2.47-2.74) and less likely to have a 30-day gap in treatment (hazard ratio = 0.48, 95% CI = 0.45-0.51).
Upward dose titration on antidepressant treatments was associated with improved medication adherence and persistence. For clinicians initiating antidepressant treatment, titrating antidepressant doses may improve patient outcomes.
评估在新开始抗抑郁治疗的前 6 个月中，向上调整抗抑郁药物剂量与药物依从性之间的关系，用于治疗患有重度抑郁症（MDD）的患者。
我们使用 Thomson Reuters MarketScan 商业索赔和遭遇索赔数据进行了回顾性观察队列研究。我们确定了 40873 名年龄在 18-64 岁之间，于 2005 年 7 月 1 日至 2007 年 6 月 30 日之间首次开始使用选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂或安非他酮的 MDD 患者。将进行滴定（定义为开始治疗时使用的剂量等于或低于美国精神病学协会治疗指南，并且在治疗的前 60 天内增加剂量）的患者与未进行滴定的患者进行比较。依从性通过抗抑郁治疗的天数覆盖率（PDC）来衡量。PDC≥80%的患者被认为是依从的。持续性通过开始治疗至抗抑郁治疗 30 天间隔的时间来衡量。多变量逻辑回归和 Cox 比例风险模型分别检查了滴定对依从性和持续性的影响。
在滴定组中，依从性高于未滴定组（67.5%比 45.2%，P<.01）。在调整选定的协变量后，滴定组的患者更有可能坚持抗抑郁治疗（优势比=2.60，95%置信区间[CI]：2.47-2.74），并且不太可能出现 30 天的治疗间隔（风险比=0.48，95%CI：0.45-0.51）。
向上调整抗抑郁药物剂量与改善药物依从性和持续性相关。对于开始抗抑郁治疗的临床医生，滴定抗抑郁药物剂量可能会改善患者的预后。
