Ouazana Vedrines Charles, Hoertel Nicolas, Lesuffleur Thomas, Denis Pierre, Olfson Mark, Blanco Carlos, Limosin Frédéric, Rachas Antoine, Tuppin Philippe, Lemogne Cédric
Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), Paris, France.
Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France.
J Clin Psychiatry. 2024 Dec 4;85(4):23m15128. doi: 10.4088/JCP.23m15128.
The prevalence of depressive and anxiety disorders is higher in women than in men. In contrast, there is still no clear consensus on the existence of sex-related differences in the effectiveness of antidepressant treatments for these disorders. This real-world study used filled prescription sequences to compare antidepressant medications between women and men at a medication level according to their acceptability (ie, combination of efficacy and tolerability). In a nationwide cohort from the French national health data system (Système National des Données de Santé [SNDS]), 1.2 million people were identified as new antidepressant users for any condition in 2011. The outcome was clinical acceptability as measured by the continuation/change ratio over the 6- month period following the introduction of the first-line treatment. Continuation was defined as at least 2 refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood stabilizer. Adjusted odds ratios (aORs) were computed through multivariable binary logistic regressions. Overall, after the first prescription of an antidepressant, the continuation/ change ratio was slightly higher for women than men (aOR [95% CI], 1.06 [1.05-1.08]), with escitalopram ranking first in both. Sex-by-medication interactions were significant for paroxetine (0.91 [0.88-0.95]) and fluoxetine (1.19 [1.12-1.26]) only. Specifically, fluoxetine was significantly more acceptable in female than in male participants (0.73 [0.70-0.75] vs 0.63 [0.60-0.67]), whereas paroxetine was more acceptable in male than in female participants (0.75 [0.72-0.78] vs 0.68 [0.66-0.70]). These real-world data may help practitioners and policymakers prioritize choice of antidepressant medications in women and men.
女性中抑郁和焦虑症的患病率高于男性。相比之下，对于这些疾病的抗抑郁治疗效果是否存在性别差异，目前仍未达成明确共识。这项真实世界研究使用已开具的处方序列，根据抗抑郁药物的可接受性（即疗效和耐受性的综合情况），在药物层面比较了女性和男性使用的抗抑郁药物。在法国国家卫生数据系统（Système National des Données de Santé [SNDS]）的全国队列中，2011年有120万人被确定为因任何情况首次使用抗抑郁药物。研究结果是通过一线治疗开始后6个月内的持续用药/换药比例来衡量临床可接受性。持续用药定义为至少2次续用同一种治疗药物。换药定义为至少有一次开具另一种抗抑郁药、抗精神病药或心境稳定剂的处方。通过多变量二元逻辑回归计算调整后的比值比（aORs）。总体而言，在首次开具抗抑郁药后，女性的持续用药/换药比例略高于男性（aOR [95% CI]，1.06 [1.05 - 1.08]），两种性别中艾司西酞普兰的排名均为第一。仅帕罗西汀（0.91 [0.88 - 0.95]）和氟西汀（1.19 [1.12 - 1.26]）存在药物与性别的交互作用。具体而言，氟西汀在女性参与者中的可接受性显著高于男性（0.73 [0.70 - 0.75] 对 0.63 [0.60 - 0.67]），而帕罗西汀在男性参与者中的可接受性高于女性（0.75 [0.72 - 0.78] 对 0.68 [0.66 - 0.70]）。这些真实世界数据可能有助于从业者和政策制定者在为女性和男性选择抗抑郁药物时确定优先顺序。
