University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Lundbeck SAS, Paris, France.
Eur Neuropsychopharmacol. 2017 Aug;27(8):773-781. doi: 10.1016/j.euroneuro.2017.05.009. Epub 2017 Jun 27.
Switching antidepressant therapy is a recommended strategy for depressed patients who neither respond to nor tolerate an initial pharmacotherapy course. This paper reviews the efficacy and tolerability of switching to vortioxetine. All three published studies of patients with major depressive disorder (MDD) switched from SSRI/SNRI therapy to vortioxetine due to lack of efficacy or tolerability were selected. Vortioxetine was evaluated versus agomelatine directly (REVIVE) and versus sertraline, venlafaxine, bupropion, and citalopram in an indirect treatment comparison (ITC) from switch studies retrieved in a literature review. Vortioxetine׳s impact on SSRI-induced treatment-emergent sexual dysfunction (TESD) was assessed directly versus escitalopram (NCT01364649) in stable patients with MDD. Vortioxetine׳s tolerability in the switch population was compared to the overall MDD population. Vortioxetine showed significant benefits over agomelatine on efficacy, functioning, and quality-of-life outcomes, with fewer withdrawals due to adverse events (AEs) (REVIVE). Vortioxetine had numerically higher remission rates versus all therapies included (ITC). Withdrawal rates due to AEs were significantly lower for vortioxetine versus sertraline, venlafaxine, and bupropion, and numerically lower versus citalopram. Switching to vortioxetine was statistically superior to escitalopram in improving TESD (NCT01364649). Tolerability was similar in the switch and overall MDD populations. These findings suggest that vortioxetine is an effective switch therapy for patients with MDD whose response to SSRI/SNRI therapy is inadequate. Vortioxetine was well tolerated and, for patients with a history of TESD, showed significant advantages versus escitalopram. Vortioxetine appears to be a valid option for patients with MDD who have not been effectively treated with first-line pharmacotherapies.
转换抗抑郁治疗是一种推荐的策略，适用于对初始药物治疗既没有反应也不能耐受的抑郁患者。本文综述了转换为文拉法辛的疗效和耐受性。所有三项关于因疗效或耐受性不佳而从 SSRI/SNRI 治疗转换为文拉法辛的重性抑郁障碍（MDD）患者的研究都被选择。文拉法辛在直接比较（REVIVE）和间接治疗比较（ITC）中分别与阿戈美拉汀和舍曲林、文拉法辛、安非他酮和西酞普兰进行了评估，从文献综述中检索到的转换研究中获得。在稳定的 MDD 患者中，文拉法辛对 SSRI 引起的治疗中出现的性功能障碍（TESD）的影响与艾司西酞普兰直接比较（NCT01364649）。转换人群的文拉法辛耐受性与总体 MDD 人群进行了比较。文拉法辛在疗效、功能和生活质量结局方面明显优于阿戈美拉汀，因不良反应（AEs）停药的比例更低（REVIVE）。文拉法辛与包括的所有药物相比，缓解率更高（ITC）。与舍曲林、文拉法辛和安非他酮相比，文拉法辛因不良反应而停药的比率显著降低，与西酞普兰相比，数值更低。与艾司西酞普兰相比，转换为文拉法辛在改善 TESD 方面具有统计学优势（NCT01364649）。在转换和总体 MDD 人群中，耐受性相似。这些发现表明，对于对 SSRI/SNRI 治疗反应不足的 MDD 患者，文拉法辛是一种有效的转换治疗方法。文拉法辛耐受性良好，对于有 TESD 病史的患者，与艾司西酞普兰相比具有显著优势。对于未有效接受一线药物治疗的 MDD 患者，文拉法辛似乎是一种有效的选择。
