Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014, Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France.
Department of Pathologies and Patients, Caisse Nationale d'Assurance Maladie, Paris, France.
J Psychiatr Res. 2023 Feb;158:180-184. doi: 10.1016/j.jpsychires.2022.12.030. Epub 2022 Dec 21.
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 replicate the results of a proof-of-concept study ranking anti-depressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. We used a nationwide cohort from the French national health data system (SNDS) to support the use of this method as a widely available tool to rank antidepressant treatments in real life settings. About 1.2 million people were identified as new antidepressant users in the SNDS in 2011. The outcome was clinical acceptability as measured by the continuation/failure ratio over the six-month period following the introduction of the first-line treatment. Continuation was defined as at least two refills of the same treatment. Failure was defined as a psychiatric hospitalization, death or at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood-stabilizer. Adjusted Odds Ratios (aOR) and 95% Confidence Interval (CI) were computed through multivariable binary logistic regressions. We ranked antidepressant medications according to clinical acceptability. Escitalopram again was the most acceptable option, and the five following antidepressants were the same as in the replication sample of the proof-of-concept study, in order Fluoxetine, Paroxetine, Sertraline, Citalopram and Venlafaxine with aOR (95% CI) for continuation ranging from 0.79 (0.77-0.81) to 0.66 (0.64-0.67). The present study provides evidence that filled prescription sequences is a widely available, robust and reproductible tool to rank antidepressant treatments in real life settings.
根据可接受性（即疗效和耐受性的结合）对抗抑郁药进行排名可能有助于选择最佳的一线药物。本研究旨在复制一项概念验证研究的结果，该研究根据与继续使用第一种治疗方法一致的处方序列比例与与改变治疗方法一致的处方序列比例对抗抑郁药进行排名。我们使用法国国家健康数据系统（SNDS）的全国性队列来支持使用这种方法作为一种广泛可用的工具，在现实生活环境中对抗抑郁治疗进行排名。在 2011 年的 SNDS 中，约有 120 万人被确定为新的抗抑郁药使用者。结果是通过在一线治疗引入后的六个月内的继续/失败比来衡量的临床可接受性。继续治疗定义为至少两次同一治疗的补充。失败定义为精神病住院、死亡或至少一次填写另一种抗抑郁药、抗精神病药或情绪稳定剂的处方。通过多变量二项逻辑回归计算调整后的优势比（aOR）和 95%置信区间（CI）。我们根据临床可接受性对抗抑郁药物进行了排名。依他普仑再次是最可接受的选择，接下来的五种抗抑郁药与概念验证研究的复制样本相同，依序为氟西汀、帕罗西汀、舍曲林、西酞普兰和文拉法辛，继续治疗的 aOR（95%CI）范围为 0.79（0.77-0.81）至 0.66（0.64-0.67）。本研究提供了证据表明，处方序列是一种广泛可用、稳健且可重复的工具，可用于在现实生活环境中对抗抑郁治疗进行排名。
