Institute of Vocational Education - Kwai Chung Campus, New Territory, Hong Kong.
Brain Behav. 2021 Aug;11(8):e2311. doi: 10.1002/brb3.2311. Epub 2021 Aug 1.
To compare the effectiveness and tolerability of agomelatine with mirtazapine in patients with depressive disorder. To illustrate the prescribing pattern of agomelatine and identify factors that affect the pattern of treatment result and therapeutic outcome of it.
The clinical data of patients using agomelatine or mirtazapine, 93 patients in each group, were included and reviewed in this retrospective study. Background characteristics, adverse events, therapeutic outcomes (discontinued or continued), reason of discontinuation, and the presence of positive pattern of treatment result were assessed. Positive pattern of treatment result was defined as either recovery or improvement of depressive disorder after therapy.
Patients using agomelatine were associated with higher starting dose and higher dose titrated than mirtazapine. More patients started agomelatine due to intolerability, and less due to ineffectiveness of the previous antidepressant. More patients started agomelatine before the use of at least two selective serotonin reuptake inhibitor (SSRI)/serotonin-noradrenaline reuptake inhibitor (SNRI). Patients using agomelatine were associated with less discontinuation due to intolerability, and less experience of adverse events within 90 days of initiation or dose increase, but more discontinuation due to ineffectiveness versus mirtazapine. The use of 50 mg resulted in less discontinuation. The use of at least two SSRI(s)/SNRI(s) before and more concomitant medications are independently associated with more discontinuation due to intolerability. The use of at least two SSRI(s)/SNRI(s) before was also associated with more adverse events. Using agomelatine as an augmentation to other antidepressant(s) and at a higher dose were independently associated with the experience of positive pattern of treatment result.
Agomelatine was more tolerable than mirtazapine, but could result in more discontinuation due to ineffectiveness. The use of higher dose and as an augmentation to other antidepressant(s) could improve the desired treatment result of agomelatine.
比较阿戈美拉汀与米氮平治疗抑郁症患者的有效性和耐受性。说明阿戈美拉汀的处方模式，并确定影响其治疗结果和治疗效果的因素。
本回顾性研究纳入了 93 例使用阿戈美拉汀和 93 例使用米氮平的患者的临床资料。评估背景特征、不良反应、治疗结果（停药或继续）、停药原因和治疗效果的阳性模式。治疗效果的阳性模式定义为治疗后抑郁障碍的恢复或改善。
使用阿戈美拉汀的患者起始剂量和滴定剂量均高于米氮平。更多患者因不耐受而开始使用阿戈美拉汀，而因先前抗抑郁药无效而开始使用的患者较少。更多患者在使用至少两种选择性 5-羟色胺再摄取抑制剂（SSRIs）/5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）之前开始使用阿戈美拉汀。使用阿戈美拉汀的患者因不耐受而停药的比例较低，在起始或剂量增加后 90 天内出现不良反应的比例也较低，但因无效而停药的比例高于米氮平。使用 50mg 剂量可降低停药率。在开始使用之前使用至少两种 SSRIs/SNRIs 和更多伴随药物与因不耐受而停药的比例增加独立相关。在开始使用之前使用至少两种 SSRIs/SNRIs 也与更多不良反应相关。将阿戈美拉汀作为其他抗抑郁药的增效剂和使用更高剂量与治疗效果阳性模式的体验独立相关。
阿戈美拉汀的耐受性优于米氮平，但因无效而停药的比例更高。使用更高剂量和作为其他抗抑郁药的增效剂可能改善阿戈美拉汀的治疗效果。
