Olekhnovitch Romain, Hoertel Nicolas, Limosin Frédéric, Blanco Carlos, Olfson Mark, Fagot-Campagna Anne, Fossati Philippe, Haffen Emmanuel, Goldberg Marcel, Zins Marie, Lemogne Cédric
Population-based Epidemiological Cohorts Unit, UMS 011 INSERM-UVSQ, 94800, Villejuif, France.
Université de Paris, Faculté de Médecine, 75006, Paris, France; AP-HP.Centre - Université de Paris, Hôpital européen Georges-Pompidou, Service de Psychiatrie et Addictologie de l'adulte et du Sujet âgé, 75105, Paris, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, F-75014, Paris, France.
J Psychiatr Res. 2020 Apr;123:72-80. doi: 10.1016/j.jpsychires.2020.01.017. Epub 2020 Jan 30.
Ranking antidepressants according to their acceptability (i.e. a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to rank antidepressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. A first step was validating this measure as a proxy of acceptability by examining the association of these two kinds of sequences with levels of depressive symptoms. Among 64,467 individuals included in the French population-based Constances cohort, reimbursements of antidepressants from January 2009 to December 2015 were extracted from the French national health insurance system claims database. Depressive symptoms were measured at inclusion with the Center for Epidemiologic Studies-Depression scale (CES-D). Between January 2010 and December 2015, 6675 participants newly initiated an antidepressant (34.5% men, mean (SD) age: 48.3 (12.1) years). Among the subsample of participants included during the six-month period following treatment initiation, individuals with continuation sequences had lower levels of depressive symptoms than those with change sequences (mean (SE) CES-D score: 18.9 (0.8) versus 26.5 (2.1), p < 0.001). According to the continuation/change ratio observed over this six-month period in all participants, escitalopram ranked first, followed by sertraline, venlafaxine, citalopram, fluoxetine and paroxetine. In an independent replication sample representative of the French national population, the same six medications ranked first, with escitalopram remaining in first place. The proportion of filled prescription sequences consistent with a continuation versus a change of the first prescribed treatment may provide a widely available measure of antidepressant acceptability in community practice.
根据抗抑郁药在普通人群中的可接受性（即疗效和耐受性的综合）进行排名，可能有助于选择最佳的一线药物。本研究旨在根据与首次治疗持续用药一致的处方序列比例与与换药一致的处方序列比例对抗抑郁药进行排名。第一步是通过检查这两种序列与抑郁症状水平之间的关联，验证该指标作为可接受性的替代指标。在法国基于人群的康斯坦斯队列纳入的64467名个体中，从法国国家健康保险系统索赔数据库中提取了2009年1月至2015年12月的抗抑郁药报销情况。入组时用流行病学研究中心抑郁量表（CES-D）测量抑郁症状。在2010年1月至2015年12月期间，6675名参与者新开始使用抗抑郁药（男性占34.5%，平均（标准差）年龄：48.3（12.1）岁）。在治疗开始后六个月内纳入的参与者子样本中，持续用药序列的个体抑郁症状水平低于换药序列的个体（平均（标准误）CES-D评分：18.9（0.8）对26.5（2.1），p<0.001）。根据所有参与者在这六个月期间观察到的持续用药/换药比例，艾司西酞普兰排名第一，其次是舍曲林、文拉法辛、西酞普兰、氟西汀和帕罗西汀。在一个代表法国全国人口的独立复制样本中，同样的六种药物排名第一，艾司西酞普兰仍居首位。与首次处方治疗的持续用药或换药一致的处方序列比例，可能为社区实践中抗抑郁药的可接受性提供一种广泛可用的衡量指标。
