Department of Biomedical and Clinical Sciences Luigi Sacco, Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.
Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Curr Neuropharmacol. 2022 Nov 15;20(12):2381-2392. doi: 10.2174/1570159X20666220222142310.
There is limited evidence about the factors influencing antidepressant (AD) prescription for the treatment of major depressive disorder (MDD) in Real World clinical practice in Italy. In this retrospective, population-based study, we set out to describe a patient cohort initiated on AD treatment for MDD and investigate the possible predictors of different AD prescriptions in the primary care setting.
Patients with a diagnosis of MDD who received an initial prescription of one of 11 selected ADs between 1-Apr-2017 and 31-Mar-2019 (index date) were identified from primary care electronic medical records in the Longitudinal Patient Database. Patients prescribed ≥1 AD in the 12 months before the index date were excluded. Results were stratified by AD molecule. Multivariable logistic regression models estimated the association between patients' demographic, clinical factors, and choice of AD molecule.
The study cohort comprised 8,823 patients (67.1% female; mean age 61.6 years). Previous AD treatments (prescribed in the 10 years before the index date) had been received by 46.6% of patients (non-naïve patients). The most commonly reported psychiatric and medical comorbidities reported in the 12 months before the index date were anxiety (8.4%) and hypertension (41.9%), respectively. Patients' age was a significant predictor of AD molecule prescribed at index date in eight of the 11 molecules investigated, while patients' gender influenced clinician prescribing bupropion, citalopram, fluoxetine, fluvoxamine, sertraline, and vortioxetine.
Results from this Real World study provide useful information for clinicians on the clinical factors influencing AD prescription in patients treated for MDD in primary care.
在意大利的真实世界临床实践中，关于影响抗抑郁药（AD）治疗重度抑郁症（MDD）处方的因素的证据有限。在这项回顾性、基于人群的研究中，我们旨在描述一个开始接受 AD 治疗 MDD 的患者队列，并调查初级保健环境中不同 AD 处方的可能预测因素。
从初级保健电子病历中的纵向患者数据库中，确定了在 2017 年 4 月 1 日至 2019 年 3 月 31 日（索引日期）之间接受 11 种选定 AD 中的一种初始处方的 MDD 诊断患者。排除了在索引日期前 12 个月内接受≥1 种 AD 处方的患者。结果按 AD 分子分层。多变量逻辑回归模型估计了患者人口统计学、临床因素与 AD 分子选择之间的关联。
研究队列包括 8823 名患者（67.1%为女性；平均年龄 61.6 岁）。46.6%的患者（非初治患者）在索引日期前 10 年中接受了之前的 AD 治疗（处方）。在索引日期前 12 个月中报告的最常见的精神科和内科合并症分别为焦虑（8.4%）和高血压（41.9%）。在调查的 11 种分子中，有 8 种分子的患者年龄是影响 AD 分子在索引日期处方的重要预测因素，而患者性别影响了医师对安非他酮、西酞普兰、氟西汀、氟伏沙明、舍曲林和沃替西汀的处方。
这项真实世界研究的结果为临床医生提供了有用的信息，了解影响初级保健中治疗 MDD 的患者 AD 处方的临床因素。
