Treatment patterns associated with Duloxetine and Venlafaxine use for Major Depressive Disorder

Abstract

BackgroundDuloxetine and venlafaxine extended release (venlafaxine XR) are SNRIs indicated for the treatment of MDD. This study addresses whether duloxetine and venlafaxine XR are interchangeable in their patterns of use with patients who are depressed or are used more selectively based on treatment history, background characteristics, and presenting symptoms.MethodsThis was a retrospective analysis of an administrative insurance claims database. We studied patients in managed care with major depressive disorder (MDD) treated with duloxetine or venlafaxine XR. Predictors of treatment and cost were assessed using Chi-square and logistic regression analyses of demographics and past-year medication use and comorbidities.ResultsPatients with MDD treated with duloxetine (n = 9,641) versus venlafaxine XR (n = 8,514) tended to be older, slightly more likely to be female, and treated by a psychiatrist (P < 0.0001). In the prior year, more duloxetine patients (vs. venlafaxine XR) received ≥3 unique antidepressants (20.8% vs. 16.6%), ≥3 unique pain medications (25.5% vs. 15.6%), and had ≥8 unique diagnosed comorbid medical and psychiatric conditions (38.6% vs. 29.1%). The prior 6-month total health care costs were $1,731 higher for duloxetine than for venlafaxine XR and declined for both medications in the 6 months after treatment began. Logistic regression analysis revealed that 61% of duloxetine patients and 61% of venlafaxine XR patients were predictable from prior patient and treatment factors.ConclusionsPatients with MDD treated with duloxetine tended to have a more complex and costly antecedent clinical presentation compared with venlafaxine XR patients, suggesting that physicians do not use the medications interchangeably.

Venlafaxine pharmacokinetics focused on drug metabolism and potential biomarkers

“…Presently, VEN is often used as an alternative drug in the treatment of selective serotonin reuptake inhibitors (SSRIs)-resistant depression being, therefore, one of the antidepressant agents most commonly prescribed worldwide [9,[12][13][14][15]. In truth, although several meta-analyses and reviews suggest that SNRIs and, in particular VEN, may be even more efficacious than SSRIs in the remission of depressive symptoms [16][17][18][19][20] and in the attainment of higher remission rates [20][21][22], not all studies support this conclusion [14,23,24]. However, VEN has been considered as a good choice for nonremitting patients [25,26].…”

The Psychological Impact of Hemodialysis on Patients with Chronic Renal Failure

“…Sertraline has safe pharmacokinetics in patients with ESRD, and treatment with sertraline in PD patients is associated with improved of QoL and fewer symptoms of depression (Atalay et al, 2010). Duloxetine and venlafaxine, which are categorized as serotonin-norepinephrine reuptake inhibitors, are beneficial for patients with major depressive disorder (Ye et al, 2011). However, these agents' safety and efficacy have not been specifically established for HD patients.…”

Local control for identifying subgroups of interest in observational research: persistence of treatment for major depressive disorder

“…Using usual care data, Ye et al . () found that patients with more comorbidities and higher prior health care costs were preferentially prescribed DLX relative to VLX. Liu et al .…”

“…Prior use (one year period) of medications included specified therapeutic classes as well as selected individual drugs known to be used in treating depression, psychosis, bipolar disorders, anxiety, sleep disorders, or chronic pain or known to be associated with initiation of DLX (Kroenke et al ., ; Liu et al ., ; Stafford et al ., ; Ye et al . ).…”