Long-term functioning outcomes are predicted by cognitive symptoms in working patients with major depressive disorder treated with vortioxetine: results from the AtWoRC study

Abstract

ObjectiveAtWoRC (Assessment in Work productivity and the Relationship with Cognitive symptoms) was an interventional, open-label, Canadian study (NCT02332954) designed to assess the association between cognitive symptoms and workplace productivity in working patients with major depressive disorder (MDD) receiving vortioxetine.MethodsEligible patients with MDD received vortioxetine (10–20 mg/day) and were assessed over 52 weeks at visits emulating a real-life setting (n = 199). Partial correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire–Depression; PDQ-D-20) and workplace productivity (Work Limitations Questionnaire; WLQ) was assessed at 12 and 52 weeks. Additional assessments included depression severity, cognitive performance, and patient-reported functioning. Structural equations model (SEM) analyses assessed causal relationships between changes in measures of cognition and functioning over time, adjusted for improvements in depressive symptoms.ResultsStatistically significant improvements in all outcomes from baseline to week 52 were seen in the overall population and both subgroups (first treatment and switch). Response and remission rates were 77% and 56%, respectively. Improvements in PDQ-D-20 and WLQ productivity loss scores at weeks 12 and 52 were significantly correlated. SEM analyses found patient-rated cognitive symptoms (PDQ-D-20) at weeks 12 and 26 were significantly predictive (p < 0.05) of patient-reported functioning (Sheehan Disability Scale) at the subsequent visit. Depression severity and objectively measured cognitive performance did not significantly predict functional outcomes at any timepoint.ConclusionThese results demonstrate the long-term benefits of vortioxetine treatment in working patients with MDD and emphasize the strong association between cognitive symptoms and functioning in a real-world setting.

<p>Impact of Cognitive Symptoms on Health-Related Quality of Life and Work Productivity in Chinese Patients with Major Depressive Disorder: Results from the PROACT Study</p>

“…While the potential for bias cannot be excluded with self-assessment of cognitive symptoms, it is possible that subjective assessment of cognitive symptoms may more closely reflect the degree of impairment experienced by patients in daily life than objective assessment in a highly standardized test setting. 52 As in other recent studies in patients with depression, 20,23,25,26,53,54 presenteeism was found to be more prevalent than absenteeism in the study population. Patients reported missing an average of 2 working days during the previous week and over half of their time spent at work was deemed unproductive (3.7 days).…”

“…This finding is not unexpected, as several other studies have also found discrepancies between self-reported measures and performance tests of cognitive symptoms in patients with MDD. 25,26,[48][49][50][51] For example, in a study in the United States involving 602 patients with MDD reporting cognitive symptoms, 64% met criteria for objectively defined cognitive impairment assessed using a battery of neuropsychological tests (including the DSST) and 48% met criteria for subjectively defined cognitive impairment assessed using the Cognitive and Physical Functioning Questionnaire (CPFQ). 50 Overall, 80% of patients met criteria for either subjective or objective cognitive impairment; however, only 31% met both criteria.…”

“…[14][15][16] Such symptoms have been shown to negatively impact both clinical and functional outcomes in patients with MDD, including HRQoL and work productivity. [17][18][19][20][21][22][23][24][25][26][27][28] However, data are lacking concerning the impact of cognitive symptoms on HRQoL and work productivity in Chinese patients with MDD. The Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study was undertaken to evaluate the prevalence and course of cognitive symptoms in Chinese patients initiating new antidepressant treatment in a real-world setting.…”

Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?

“…The presence of cognitive symptoms affects patient functioning broadly, including difficulty in maintaining performance at work, experiencing household and financial strains, and difficulty in participating in social life (30)(31)(32). Improvements in these symptoms have been shown to precede improvements in functional outcome, even after adjustment for depressive symptom severity (33)(34)(35). Our findings may indicate that patients experience the functional consequences of cognitive symptoms in the short term to a much greater extent than realized or observed by HCPs and therefore report them as significant over and above depressive symptoms.…”

Canadian economic impact of improved workplace productivity in patients with major depressive disorder treated with vortioxetine

“…21 The Assessment in Work productivity and the Relationship with Cognitive symptoms study (AtWoRC; NCT02332954) is an interventional, open-label, Canadian study primarily designed to assess the association between cognitive symptoms and work productivity in gainfully employed patients with MDD and who were being treated with 10-20 mg of vortioxetine daily. 22,23 The AtWoRC study was conducted in 26 centers across Canada by 9 psychiatrists and 17 primary care physicians. To be eligible, patients had to be currently experiencing a confirmed major depressive episode (MDE) for at least 3 months, and to be employed full-time (described as ≥20 h weekly) or enrolled in full-time post-secondary studies or vocational training.…”