Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.
Duke University School of Medicine, Durham, NC, USA.
J Med Econ. 2024 Jan-Dec;27(1):1003-1010. doi: 10.1080/13696998.2024.2382641. Epub 2024 Aug 4.
Major depressive disorder (MDD) is a prevalent, chronic disorder. Auvelity (dextromethorphan-bupropion) is a novel, oral -methyl-D-aspartate (NMDA) receptor antagonist and sigma-1 receptor agonist approved (August 2022) by the FDA for treating MDD in adults. This is the first analysis on real-world Auvelity usage in the United States.
Adult patients initiating Auvelity in the Symphony IDV databases by September 2023 were identified (index date: the first Auvelity claim). Patients had continuous eligibility over the 12-month pre-index period and ≥1 MDD diagnosis (ICD-10-CM codes: F32., F33.) over the 5-year pre-index period. Demographic and clinical characteristics, comorbidities, prior MDD-related medications, and Auvelity initiation status were assessed.
This analysis included 22,288 patients with MDD treated with Auvelity (mean age 45.1 years; 68.1% women); 40.0% lived in the South and 58.5% had commercial insurance. Comorbidities included mental health disorders (53.5%; 47.6% had anxiety disorders). Overall, 83.7% of the patients had received treatment with selective serotonin reuptake inhibitors (SSRIs; 54.9%), the norepinephrine-dopamine reuptake inhibitor (NDRI [bupropion]; 40.4%), and/or serotonin-norepinephrine reuptake inhibitors (SNRIs; 35.9%) over the 12-month pre-index period. The last MDD-related treatment prior to Auvelity comprised SSRI (22.4%), SNRI (13.2%), and NDRI (12.8%) monotherapies; 294 (1.3%) patients received esketamine. In total, 6,418 (28.8%) patients initiated Auvelity as monotherapy vs 15,870 (71.2%) as an add-on; Auvelity was most frequently added to an SSRI alone (10.7%) or SNRI alone (6.5%). A total of 2,254 (10.1%) patients initiated Auvelity without prior treatment in the 12-month pre-index period.
Incomplete data due to reporting; diagnoses captured subject to coding error; and limited generalizability to other populations.
Using a large demographically distributed claims database, 22,288 patients with MDD initiated Auvelity within a year of its approval; 10.1% were treatment-naïve and 28.8% initiated Auvelity as monotherapy. Most patients had mental health-related comorbidities and attempted various MDD-related treatments prior to Auvelity.
重度抑郁症（MDD）是一种普遍存在且慢性的疾病。Auvelity（右美沙芬-安非他酮）是一种新型的、口服的 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂和 sigma-1 受体激动剂，于 2022 年 8 月获得 FDA 批准用于治疗成年 MDD。这是美国首个关于 Auvelity 实际应用的分析。
通过 Symphony IDV 数据库，于 2023 年 9 月前确定开始使用 Auvelity 的成年患者（索引日期：首次 Auvelity 索赔）。患者在 12 个月的预索引期内连续符合条件，且在 5 年的预索引期内至少有 1 次 MDD 诊断（ICD-10-CM 代码：F32.，F33.）。评估了人口统计学和临床特征、合并症、先前的 MDD 相关药物治疗和 Auvelity 起始情况。
该分析纳入了 22288 例 MDD 患者，接受 Auvelity 治疗（平均年龄 45.1 岁；68.1%为女性）；40.0%居住在南部，58.5%有商业保险。合并症包括精神健康障碍（53.5%；47.6%有焦虑障碍）。总体而言，83.7%的患者在 12 个月的预索引期内接受过选择性 5-羟色胺再摄取抑制剂（SSRIs；54.9%）、去甲肾上腺素-多巴胺再摄取抑制剂（安非他酮；40.4%）和/或 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs；35.9%）治疗。在 Auvelity 之前的最后一次 MDD 相关治疗包括 SSRI（22.4%）、SNRI（13.2%）和 NDRI（安非他酮；12.8%）单药治疗；294（1.3%）例患者接受 Esketamine 治疗。共有 6418 例（28.8%）患者起始 Auvelity 单药治疗，15870 例（71.2%）患者起始 Auvelity 联合治疗；Auvelity 最常与 SSRI （10.7%）或 SNRI （6.5%）联合使用。共有 2254 例（10.1%）患者在预索引期内没有接受 Auvelity 之前的治疗。
由于报告不完整，存在数据缺失；捕获的诊断易受编码错误的影响；并且对其他人群的推广有限。
使用一个具有代表性的大型索赔数据库，22288 例 MDD 患者在 Auvelity 获得批准后一年内开始使用该药；10.1%的患者为治疗初治患者，28.8%的患者起始 Auvelity 单药治疗。大多数患者有精神健康相关合并症，并且在使用 Auvelity 之前尝试了各种 MDD 相关治疗。
