Comparative evaluation of vortioxetine as a switch therapy in patients with major depressive disorder

Abstract

Switching antidepressant therapy is a recommended strategy for depressed patients who neither respond to nor tolerate an initial pharmacotherapy course. This paper reviews the efficacy and tolerability of switching to vortioxetine. All three published studies of patients with major depressive disorder (MDD) switched from SSRI/SNRI therapy to vortioxetine due to lack of efficacy or tolerability were selected. Vortioxetine was evaluated versus agomelatine directly (REVIVE) and versus sertraline, venlafaxine, bupropion, and citalopram in an indirect treatment comparison (ITC) from switch studies retrieved in a literature review. Vortioxetine׳s impact on SSRI-induced treatment-emergent sexual dysfunction (TESD) was assessed directly versus escitalopram (NCT01364649) in stable patients with MDD. Vortioxetine׳s tolerability in the switch population was compared to the overall MDD population. Vortioxetine showed significant benefits over agomelatine on efficacy, functioning, and quality-of-life outcomes, with fewer withdrawals due to adverse events (AEs) (REVIVE). Vortioxetine had numerically higher remission rates versus all therapies included (ITC). Withdrawal rates due to AEs were significantly lower for vortioxetine versus sertraline, venlafaxine, and bupropion, and numerically lower versus citalopram. Switching to vortioxetine was statistically superior to escitalopram in improving TESD (NCT01364649). Tolerability was similar in the switch and overall MDD populations. These findings suggest that vortioxetine is an effective switch therapy for patients with MDD whose response to SSRI/SNRI therapy is inadequate. Vortioxetine was well tolerated and, for patients with a history of TESD, showed significant advantages versus escitalopram. Vortioxetine appears to be a valid option for patients with MDD who have not been effectively treated with first-line pharmacotherapies.

Successfully treated patients with vortioxetine versus venlafaxine: a simplified cost-effectiveness analysis based on a head-to-head study in Asian patients with major depressive disorder

“…In this study, significantly more patients were treated successfully with vortioxetine compared with venlafaxine XR when assessing symptomatic response in combination with either optimal tolerability or functional remission. Particularly, these results support the favorable tolerability and benefit-risk profile of vortioxetine relative to other antidepressants that has previously been reported 9,10,20,27,28 . The results further corroborate previous findings that vortioxetine, in addition to effectively treating mood symptoms, has a broader effect on overall patient functioning 29 .…”

Intravenous vortioxetine to accelerate onset of effect in major depressive disorder: a 7-day randomized, double-blind, placebo-controlled exploratory study

“…This study confirmed the favorable tolerability profile that has previously been shown with vortioxetine, also as a switch therapy ( Baldwin et al ., 2016 a; Thase et al ., 2017 ). In this study, switching patients directly and rapidly from an SSRI/SNRI to a single high dose of vortioxetine did not compromise tolerability, with lower levels of nausea compared both with the previous examination of 17 mg IV vortioxetine in a nonswitch population ( Vieta et al ., 2019 ) and with oral doses of vortioxetine (5–20 mg) ( Baldwin et al ., 2016 a), likely reflecting tolerance to the side effects elicited by SERT inhibition developed with the previous SSRI/SNRI therapy.…”

Vortioxetine as a new frontier in the treatment of chronic neuropathic pain: a review and update

“…Moreover, in patients who had exhibited an inadequate response to SSRIs or SNRIs before switching to VO, 146 this drug proved to be significantly superior to agomelatine in terms of reducing depressive symptoms in SSRI non-responders, 147 although not in SNRI patients. 141 …”