Ameli Omid, Soria-Saucedo Rene, Smith Eric G, Cabral Howard J, Soley-Bori Marina, Kazis Lewis E
From the *Boston University School of Public Health, and †Boston University School of Public Health, Health Law Policy and Management Department, Boston; ‡Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford; §Department of Psychiatry, University of Massachusetts Medical School, Worcester; ∥Department of Biostatistics, Boston University School of Public Health, and ¶Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, MA.
J Clin Psychopharmacol. 2017 Jun;37(3):323-331. doi: 10.1097/JCP.0000000000000687.
Treatment augmentation is an important clinical decision in the pharmacotherapy for depression, yet few studies have examined the rates of treatment augmentation by medication class.
The aim of this study was to examine which initial pharmacotherapies for depression are more likely than others to result in subsequent treatment augmentation.
This study is a retrospective cohort analysis of administrative data of 214,705 privately insured US adults between the age of 18 and 64 years who were diagnosed with a new episode of depression in 2009. Propensity score-adjusted logistic regression and Cox regression were used to model the effect of the class of initial monotherapy on treatment augmentation. Risk adjustors included depression severity, comorbidities, provider type, insurance, and demographic characteristics.
The class of initial monotherapy and the health care provider type were the main independent variables of interest.
The outcome was the augmentation of monotherapy.
Thirty-four percent of individuals received treatment augmentation. Compared with selective serotonin reuptake inhibitor monotherapy, second-generation antipsychotics as the initial treatment were associated with significant increase in the likelihood of augmentation compared with the other classes (hazards ratio, 2.59; 95% confidence interval [CI], 2.51-2.68). This result was corroborated after propensity score adjustment (odds ratio, 2.85; 95% CI, 2.70-3.00) when comparing second-generation antipsychotics to the other classes of pharmacotherapy. The other significant predictor of treatment augmentation was the provider type. Mental health specialists were 27% more likely to augment a treatment compared with generalists (hazards ratio, 1.27; 95% CI, 1.25-1.30).
The type of initial antidepressant therapy is associated with the chances of treatment augmentation. Second-generation antipsychotics progressed to augmentation more rapidly than the other classes.
增效治疗是抑郁症药物治疗中的一项重要临床决策，但很少有研究按药物类别考察增效治疗的比例。
本研究旨在考察哪些抑郁症初始药物治疗比其他治疗更有可能导致后续增效治疗。
本研究是一项对214705名年龄在18至64岁之间、2009年被诊断为新发抑郁症的美国私人保险成年人的行政数据进行的回顾性队列分析。采用倾向评分调整后的逻辑回归和Cox回归对初始单药治疗类别对增效治疗的影响进行建模。风险调整因素包括抑郁严重程度、合并症、医疗服务提供者类型、保险和人口统计学特征。
初始单药治疗类别和医疗服务提供者类型是主要的感兴趣的自变量。
结局为单药治疗的增效情况。
34%的个体接受了增效治疗。与选择性5-羟色胺再摄取抑制剂单药治疗相比，第二代抗精神病药物作为初始治疗与其他类别相比，增效可能性显著增加（风险比，2.59；95%置信区间[CI]，2.51 - 2.68）。在将第二代抗精神病药物与其他药物治疗类别进行比较时，倾向评分调整后这一结果得到证实（优势比，2.85；95%CI，2.70 - 3.00）。增效治疗的另一个显著预测因素是医疗服务提供者类型。与普通医生相比，心理健康专家使治疗增效的可能性高27%（风险比，1.27；95%CI，1.25 - 1.30）。
初始抗抑郁治疗的类型与增效治疗的机会相关。第二代抗精神病药物比其他类别更快进展到增效治疗。
