Comparative Assessment of Adherence Measures and Resource Use in SSRI/SNRI-Treated Patients with Depression Using Second-Generation Antipsychotics or L-Methylfolate as Adjunctive Therapy

Wade, Rolin L.; Kindermann, Sylvia L.; Hou, Qi; Thase, Michael E.

doi:10.18553/jmcp.2014.20.1.76

Cited by 24 publications

(23 citation statements)

References 37 publications

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“…To ensure ADs were being used to treat a new diagnosis of MDD, patients with claims for certain conditions were excluded from the dataset if they occurred within 6 months before to 12 months after the IDD (Appendix 2). These include schizophrenic disorder (ICD-9 code: 295), bipolar disorder (296.0–296.1 and 296.4–296.9), other psychosis-related disorders, paranoid states (297), other mood disorders (293.83 and 301.13), drug-induced depression (292.84), depressive-type psychosis (298), Alzheimer’s disease (331), Parkinson’s disease (332), and dementia (290) [12, 14, 22]. In addition, patients who had a claim for pregnancy (630–679) were excluded from the dataset because of the effect pregnancy may have on discontinuation of therapy.…”

Section: Methodsmentioning

confidence: 99%

Adherence and Persistence Across Antidepressant Therapeutic Classes: A Retrospective Claims Analysis Among Insured US Patients with Major Depressive Disorder (MDD)

et al. 2017

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BackgroundAdherence and persistence to therapy, or how well a patient follows provider directions on frequency and time to discontinuation of prescribed medications, is associated with positive health outcomes, including decreased healthcare costs and patient mortality. A clear literature gap exists assessing adherence and persistence to antidepressants (ADs) in the major depressive disorder (MDD) population at clinically relevant time points and at the therapeutic class level.ObjectiveThis study assessed adherence and persistence to specific ADs, therapeutic classes, and AD therapy overall at multiple time points among US individuals from commercial, Medicare supplemental, and Medicaid insurance plans.MethodsPatients with MDD without AD or MDD claims in the prior 6 months who initiated therapy in 2003–2014 with a selective serotonin reuptake inhibitor (SSRI), serotonin and norepinephrine reuptake inhibitor (SNRI), tricyclic AD (TCA), monoamine oxidase inhibitor (MAOI), or other AD were identified using MarketScan® databases. These databases contain information on diagnoses, billing codes, and dates of service. Adherence (proportion of days covered) and persistence (days until a 30-day gap in therapy) were calculated to AD medication, AD therapeutic class, and AD therapy overall over the first 3, 6, 9, and 12 months from the index prescription date. Multivariable logistic regression estimated the adjusted odds ratios (ORs) of adherence to initial AD medication comparing AD therapeutic classes.ResultsFor 527,907 patients, adherence to initial AD medication decreased over 3, 6, 9, and 12 months (41, 31, 24, and 21%, respectively). Similar patterns were observed for adherence to initial AD therapeutic class, AD therapy overall, and all three persistence calculations. The odds of adherence to SNRIs versus SSRIs were 20–27% greater at 3, 6, 9, and 12 months (ORs 1.20, 1.23, 1.25, 1.27, respectively; p-values all <0.0001). Similar or significantly lower odds of adherence were demonstrated for other classes versus SSRIs at 3, 6, 9, and 12 months [ORs for other ADs 0.80, 0.77, 0.74, 0.72, respectively (p-values all <0.0001); ORs for TCAs 0.46, 0.45, 0.47, 0.49, respectively (p-values all <0.0001); ORs for MAOIs 1.13, 1.0, 0.77, 0.69, respectively (p-values all >0.05)].ConclusionWe found low adherence and persistence to ADs in the MDD population. Within the limitations of the insurance claims data we analysed, our results suggest that adherence may differ based on therapeutic class, as patients initiating SNRI therapy appeared to have a higher likelihood of adherence versus SSRIs over the year assessed, while the odds of adherence appeared similar or lower for other classes versus SSRIs. Further prospective research is needed to confirm these findings and determine additional drivers of these apparent differences by AD therapeutic class.Electronic supplementary materialThe online version of this article (doi:10.1007/s40263-017-0417-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Adherence and Persistence Across Antidepressant Therapeutic Classes: A Retrospective Claims Analysis Among Insured US Patients with Major Depressive Disorder (MDD)

et al. 2017

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“…19 Several studies have demonstrated l-methylfolate as an effective augmentation strategy with SSRI/SNRIs. 99,100 Comparative assessment of adherence measures and resource use in SSRI/SNRI-treated patients with depression using second-generation antipsychotics or L-methylfolate as adjunctive therapy http://www.ncbi.nlm.nih.gov/pubmed/24372461 101 "Patients who augmented SSRI/SNRI therapy with second-generation atypical antipsychotics (SGA) or Lmethylfolate achieved modified application of the HEDIS (mHEDIS) acute medication management (AMM) acute phase and continuation phase adherence scores of 69%-79% and 50%-62%, respectively. These modified scores exceeded the 2012 national median benchmarks for unmodified HEDIS AMM measures for commercial health plans.…”

Section: Treatment Of Cognitive Deficits Associated With Schizophrenimentioning

confidence: 99%

Polymorphisms in Serotonergic Pathways Influence the Outcome of Antidepressant Therapy in Psychiatric Inpatients

Staeker

Leucht

Laika

et al. 2014

Genetic Testing and Molecular Biomarkers

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Serotonergic pathways are known to play an essential role in the effects generated by antidepressants. Polymorphisms in serotonin receptor and transporter genes have been identified as an important factor. To investigate which of these polymorphisms may be useful to predict clinical outcome, we assessed their effect in a naturalistic clinical study. We studied the influence of the 5-hydroxytryptamine transporter (5-HTT) variable number of tandem repeats (VNTR), 5-HTTLPR/rs25531 and a 5-HTR2A intron 2 SNP with regard to response and side effects in 273 psychiatric inpatients. Main clinical assessments included Clinical Global Impressions ratings, paranoid depression scale self-rating scale and Dosage Record, and Treatment Emergent Symptoms (DOTES) Scale. We found significant associations between 5-HTTLPR/rs25531 S/L(G) alleles and response and side effects in 100 patients with selective serotonin reuptake inhibitor (SSRI) treatment (p = 0.037, CGI-I ≤ 2: 0% vs. 19% and p = 0.0005, DOTES cluster c: 0.76 vs. 0.19). 5-HTT VNTR and 5-HTR2A intron 2 polymorphisms were associated significantly with adverse effects in patients with selective and nonselective SRI (5-HTT VNTR 12/12: n = 170, p = 0.0001, side effect rates: 51% vs. 19% and rs7997012 [A/A]: n = 50, p = 0.020, side effects rates: 43% vs. 11%). No impact of the polymorphisms on mirtazapine treatment was found. Our study confirms the influence of serotonergic polymorphisms at the receptor and transporter level on SSRI response and side effects, supporting previous reports based on various study designs. The effects were strong enough to be noticed clinically in this naturalistic setting. However, randomized controlled trials are warranted to provide unequivocal evidence of the clinical usefulness of pretherapeutic screening for these polymorphisms.

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“…SSRI). The use of second-generation antipsychotics as adjuvants to SSRIs has been investigated and approved for clinical use to treat depression, particularly treatment-resistant depression, late-life depression and co-morbid MDD and alcohol dependence [75][76][77]. The combination of an SSRI and an antipsychotic has been proven to be more effective than a SSRI alone in patients with MDD [78].…”

Section: Effects Of Novel Strategiesmentioning

confidence: 99%

Neuroadaptations of the 5-HT System Induced by Antidepressant Treatments: Old and New Strategies

Haddjeri¹

2014

AAD

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Major Depressive Disorder (MDD) is a common illness worldwide with severe socioeconomic consequences. Several hypotheses have been formulated to explain the physiopathology of depression as well as the mechanism of action of antidepressants but two of them had attracted much attention. The dominant monoaminergic hypothesis of depression links the physiopathology of MDD to a deficiency on cerebral serotonin (5-HT) and/or Norepinephrine (NE) levels; however, the relatively new neurogenic and neurotrophic hypothesis raises the possibility of an impaired neuroplasticity and/or depletion of neurotrophic factors in specific networks resulting on their structural deformity and functional impairment. An enormous body of evidence reported particular neuroadaptations following chronic administration of antidepressant drugs. In this review, we describe major adaptive changes in pre-and post-synaptic 5-HT neurotransmission as well as alterations in gene transcription and neurotrophic factors in response to long-term treatment with conventional antidepressants, new putative ones or novel promising drug candidates, all acting via 5-HT system.

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Comparative Assessment of Adherence Measures and Resource Use in SSRI/SNRI-Treated Patients with Depression Using Second-Generation Antipsychotics or L-Methylfolate as Adjunctive Therapy

Cited by 24 publications

References 37 publications

Adherence and Persistence Across Antidepressant Therapeutic Classes: A Retrospective Claims Analysis Among Insured US Patients with Major Depressive Disorder (MDD)

Adherence and Persistence Across Antidepressant Therapeutic Classes: A Retrospective Claims Analysis Among Insured US Patients with Major Depressive Disorder (MDD)

Polymorphisms in Serotonergic Pathways Influence the Outcome of Antidepressant Therapy in Psychiatric Inpatients

Neuroadaptations of the 5-HT System Induced by Antidepressant Treatments: Old and New Strategies

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