University of Maryland School of Pharmacy, Baltimore.
J Manag Care Spec Pharm. 2024 Dec;30(12):1455-1466. doi: 10.18553/jmcp.2024.30.12.1455.
Individuals with depression who do not respond to initial antidepressant may switch to a different antidepressant, add a second antidepressant, or add an atypical antipsychotic. Previous studies comparing these strategies' efficacy and safety reported conflicting results, and the impact of these strategies on subsequent health care utilization is unknown.
To compare health care utilization between individuals with depression who switched antidepressants, added a second antidepressant (ie, combination), or added an atypical antipsychotic (ie, augmentation) following their initial antidepressant.
This retrospective cohort study used a 25% random sample of the IQVIA PharMetrics Plus for Academics health plan claims database. The study cohort included individuals aged 10-64 years who newly initiated an antidepressant at any point from January 2016 to December 2020. New use was defined as no evidence of an antidepressant in the 180 days preceding the antidepressant dispensing. Individuals had to have a depression diagnosis and a treatment change in the 180 days following the initial antidepressant. The index date was the date of the first observed antidepressant change, which was defined as a switch, combination, or augmentation. Health care utilization, measured as the number of outpatient visits, any all-cause hospitalization, and any emergency department (ED) visit, was assessed in the 180 days after the index date. Negative binomial regression models evaluated the rate ratio of the number of outpatient visits. Logistic regression models estimated the odds ratio of a hospitalization, and modified Poisson regression estimated the relative risk of an ED visit. Models were adjusted for demographics, clinical characteristics, and previous health care utilization.
Among 3,847 individuals with depression who had the first treatment change following the initial antidepressant, we identified 2,418 (62.9%) who switched, 1,268 (33.0%) who combined, and 161 (4.2%) who augmented their antidepressant. The augmentation group had a significantly higher rate of outpatient visits than the combination group (adjusted rate ratio = 1.14, 95% CI = 1.04-1.25). There was no statistically significant difference in hospitalizations or ED visits between the switch and augmentation vs combination groups.
Augmentation comprised 4% of our antidepressant cohort but had higher outpatient health care utilization than those who combined treatment.
初始抗抑郁治疗无应答的抑郁症患者可能会转而使用另一种抗抑郁药、添加第二种抗抑郁药（即联合治疗）或添加一种非典型抗精神病药（即增效治疗）。先前比较这些策略疗效和安全性的研究报告结果相互矛盾，且这些策略对后续医疗保健利用的影响尚不清楚。
比较初始抗抑郁治疗后转换抗抑郁药、添加第二种抗抑郁药（即联合治疗）或添加一种非典型抗精神病药（即增效治疗）的抑郁症患者的医疗保健利用情况。
本回顾性队列研究使用了 IQVIA PharMetrics Plus for Academics 健康计划索赔数据库的 25%随机样本。研究队列包括 2016 年 1 月至 2020 年 12 月期间任何时候首次使用抗抑郁药的年龄在 10-64 岁的个体。新用药定义为在抗抑郁药配药前的 180 天内没有抗抑郁药的证据。个体必须有抑郁症诊断，并在初始抗抑郁药治疗后 180 天内有治疗改变。索引日期为首次观察到的抗抑郁药改变的日期，定义为转换、联合治疗或增效治疗。在索引日期后的 180 天内，评估门诊就诊次数、任何全因住院治疗和任何急诊就诊次数等医疗保健利用情况。使用负二项式回归模型评估门诊就诊次数的比率比。使用逻辑回归模型估计住院治疗的比值比，使用修正泊松回归估计急诊就诊的相对风险。模型调整了人口统计学、临床特征和以前的医疗保健利用情况。
在 3847 名有初始抗抑郁治疗后首次治疗改变的抑郁症患者中，我们确定了 2418 名（62.9%）转换、1268 名（33.0%）联合治疗和 161 名（4.2%）增效治疗的患者。增效治疗组的门诊就诊次数明显高于联合治疗组（调整后的比率比=1.14，95%CI=1.04-1.25）。转换组和增效组与联合组相比，住院率和急诊就诊率无统计学差异。
增效治疗占我们抗抑郁药队列的 4%，但其门诊医疗保健利用率高于联合治疗。
