Prescription patterns following first-line new generation antidepressants for depression in Japan: A naturalistic cohort study based on a large claims database

Furukawa, Toshi A; Onishi, Yoshie; Hinotsu, Shiro; Tajika, Aran; Takeshima, Nozomi; Shinohara, Kiyomi; Ogawa, Yoshihide; Hayasaka, Yu; Kawakami, Koji

doi:10.1016/j.jad.2013.05.015

Cited by 21 publications

(12 citation statements)

References 20 publications

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“…In the present study, we recognized that the doses of antidepressants were generally low in real practice in Japan, which was consistent with the previous research. 19 This is in agreement with the low AE frequency observed in our study. Particularly, the duloxetine average dose (mean [standard deviation]: 29.7 [11.7] mg/day, median: 25.2 mg/day) was much lower than the lower limit of the approved treatment dose specified in the Japanese package insert, while the SSRI average doses were near or exceeded the lower limit of the approved treatment doses.…”

Section: Discussionsupporting

confidence: 93%

An observational study of duloxetine versus SSRI monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis

Kuga

Tsuji

Hayashi

et al. 2017

NDT

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ObjectiveThe objective of this study was to assess the effectiveness of duloxetine monotherapy, in comparison with selective serotonin reuptake inhibitor (SSRI) monotherapy, in the treatment of painful physical symptoms (PPS) in Japanese patients with major depressive disorder (MDD) in real-world clinical settings.MethodsThis was a multicenter, 12-week prospective, observational study. This study enrolled MDD patients with at least moderate PPS, defined as a Brief Pain Inventory-Short Form (BPI-SF) average pain score (item 5) ≥3. Patients were treated with duloxetine or SSRIs (escitalopram, sertraline, paroxetine, or fluvoxamine) for 12 weeks, and PPS were assessed by BPI-SF average pain score. The primary outcome was early improvement in the BPI-SF average pain score at 4 weeks post-baseline.ResultsA total of 523 patients were evaluated for treatment effectiveness (duloxetine N=273, SSRIs N=250). The difference in BPI-SF average pain score between the two groups was not statistically significant at 4 weeks post-baseline, the primary endpoint (least-squares mean change from baseline [95% confidence interval]: duloxetine, −2.8 [−3.1, −2.6]; SSRIs, −2.5 [−2.8, −2.3]; P=0.166). There was a numerical advantage for duloxetine in improvement from 4 to 12 weeks post-baseline, and the difference was statistically significant at 8 weeks post-baseline (least-squares mean change from baseline [95% confidence interval]: duloxetine, −3.6 [−3.9, −3.3]; SSRIs, −3.1 [−3.4, −2.8]; P=0.023). The 30% and 50% responder rates were significantly higher in patients treated with duloxetine at 4 and 8 weeks post-baseline. There were no serious adverse events experienced by duloxetine-treated patients. The rate of discontinuations due to adverse events was similar for duloxetine and the SSRIs (1.0% and 0.8% of patients, respectively).ConclusionIn this observational study, BPI-SF improvement was not significantly different at 4 weeks, the primary endpoint; however, patients treated with duloxetine tended to show better improvement in PPS compared to those treated with SSRIs.

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Section: Discussionsupporting

confidence: 93%

An observational study of duloxetine versus SSRI monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis

Kuga

Tsuji

Hayashi

et al. 2017

NDT

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“…Despite these limitations, our results may help guide policy decisions regarding mental healthcare and related expenditures in Japan, as these fields are being increasingly affected by the aging population. Therefore, further research is needed to provide more detailed longitudinal prescription data for antipsychotic prescriptions, similar to our previous studies of antidepressants …”

Section: Discussionmentioning

confidence: 86%

Trends in antipsychotic prescriptions for Japanese outpatients during 2006-2012: a descriptive epidemiological study

Kochi

Sato

Nishiyama

et al. 2017

Pharmacoepidemiol Drug Saf

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“…The assessment intervals in this study were 1 week or more even in the first 4 weeks because the priority was to ensure a routine psychiatric practice setting was maintained above the experimental considerations. Previous survey studies of antidepressant prescriptions for treating depression in general clinical practice demonstrated that patients discontinue an initial antidepressant in the first 4 weeks at a rate of 26.2–42.4 % [ 39 – 42 ]. The present results of the dropout rate evaluation were similar to the previously reported rates in general clinical practice [ 39 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of mirtazapine versus selective serotonin reuptake inhibitors on benzodiazepine use in patients with major depressive disorder: a pragmatic, multicenter, open-label, randomized, active-controlled, 24-week trial

et al. 2016

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BackgroundThis study aimed to evaluate whether selecting mirtazapine as the first choice for current depressive episode instead of selective serotonin reuptake inhibitors (SSRIs) reduces benzodiazepine use in patients with major depressive disorder (MDD). We concurrently examined the relationship between clinical responses and serum mature brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF.MethodsWe conducted an open-label randomized trial in routine psychiatric practice settings. Seventy-seven MDD outpatients were randomly assigned to the mirtazapine or predetermined SSRIs groups, and investigators arbitrarily selected sertraline or paroxetine. The primary outcome was the proportion of benzodiazepine users at weeks 6, 12, and 24 between the groups. We defined patients showing a ≥50 % reduction in Hamilton depression rating scale (HDRS) scores from baseline as responders. Blood samples were collected at baseline, weeks 6, 12, and 24.ResultsSixty-five patients prescribed benzodiazepines from prescription day 1 were analyzed for the primary outcome. The percentage of benzodiazepine users was significantly lower in the mirtazapine than in the SSRIs group at weeks 6, 12, and 24 (21.4 vs. 81.8 %; 11.1 vs. 85.7 %, both P < 0.001; and 12.5 vs. 81.8 %, P = 0.0011, respectively). No between-group difference was observed in HDRS score changes. Serum proBDNF levels were significantly decreased (χ 2 = 8.5, df = 3, P = 0.036) and serum mature BDNF levels were temporarily significantly decreased (F = 3.5, df = 2.4, P = 0.027) in the responders of both groups at week 24.ConclusionThis study demonstrated mirtazapine as the first-choice antidepressant for current depressive episodes may reduce benzodiazepine use in patients with MDD. Trial registration UMIN000004144. Registered 2nd September 2010. The date of enrolment of the first participant to the trial was 24th August 2010. This study was retrospectively registered 9 days after the first participant was enrolled

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Prescription patterns following first-line new generation antidepressants for depression in Japan: A naturalistic cohort study based on a large claims database

Cited by 21 publications

References 20 publications

An observational study of duloxetine versus SSRI monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis

An observational study of duloxetine versus SSRI monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis

Trends in antipsychotic prescriptions for Japanese outpatients during 2006-2012: a descriptive epidemiological study

Effect of mirtazapine versus selective serotonin reuptake inhibitors on benzodiazepine use in patients with major depressive disorder: a pragmatic, multicenter, open-label, randomized, active-controlled, 24-week trial

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