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Del Pino-Sedeño T, Infante-Ventura D, Hernández-González D, González-Hernández Y, González de León B, Rivero-Santana A, Hurtado I, Acosta Artiles FJ. Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis. Front Pharmacol 2024; 15:1327155. [PMID: 38318137 PMCID: PMC10839896 DOI: 10.3389/fphar.2024.1327155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | | | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
| | - Isabel Hurtado
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Health care Programs, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Shin G, Jang B, Bae G, Jeon HL, Bae S. The Impact of Payment Scheme Changes on Medication Adherence and Persistence of Patients Diagnosed with Depression in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11100. [PMID: 36078819 PMCID: PMC9517799 DOI: 10.3390/ijerph191711100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
As of 1 July 2018, the Korean National Health Insurance Service (NHIS) changed the fee schedule for individual psychotherapy (IP). We sought to analyze the impact of the IP payment scheme changes on the medication adherence and persistence of patients diagnosed with depression in Korea. We utilized the NHIS claims database from 2017 to 2019. Patients who were newly diagnosed with depression and utilized IP and were prescribed antidepressants during the study period were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the length of therapy (LOT) during the follow-up period. Adherence and persistence during the pre-policy period (before the change of the payment scheme, from January 2018 until June 2018) and the post-policy period (after the change, from July 2018 until December 2019) were compared. During the study period, a total of 176,740 patients with depression were identified. The average MPR significantly increased from 0.20 to 0.33 in the pre- and post-policy periods, respectively (p < 0.001). The average LOT of the patients improved considerably from 36 to 56 days in the pre- and post-policy periods, respectively (p < 0.001). Poisson regression analysis showed that patients with depression who were female, 19-34 years of age (vs. 50-64 years or over 64 years), and in the post-policy period were significantly associated with greater adherence and persistence rates. Payment scheme changes were associated with an increased adherence and persistence of medication use among patients diagnosed with depression.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Bohwa Jang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Green Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Ha-Lim Jeon
- School of Pharmacy, Jeonbuk National University, Jeonju 54896, Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
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Mulder HA, McIntire GL, Wallace FN, Poklis JL. Determination of Patient Adherence for Duloxetine in Urine. J Anal Toxicol 2022; 46:905-910. [PMID: 35748596 PMCID: PMC9564183 DOI: 10.1093/jat/bkac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 01/26/2023] Open
Abstract
Duloxetine, known by its brand name, CymbaltaTM, is a selective serotonin and norepinephrine reuptake inhibitor used to treat major depressive disorders. Determination of patient compliance for duloxetine is typically determined through medication possession ratio (MPR) or plasma concentrations. The purpose of this paper was to characterize normal urinary duloxetine concentrations in patients prescribed duloxetine to monitor patient adherence. Patient data collected from routine screens for duloxetine concentrations in urine were included in this study. Inclusion criteria consisted of patients who were prescribed duloxetine and (i) tested positive for duloxetine, (ii) tested negative for illicit substances and (iii) included creatinine, age and duloxetine dose administered. Of the 5,592 patient urines screened, 2,004 of the results fit into the inclusion criteria. Positive urine concentrations of duloxetine ranged from 50 to 2,722 ng/mL. Duloxetine urine concentrations were normalized to creatinine and dose further characterized by sex, age, body mass index (BMI) and dose in milligrams. Sample distribution included urines collected from 1,487 females and 517 males. The age range of the specimen donors was between 15 and 90 years old with an average age of 52. BMI levels ranged from 13.9 (underweight) to 88.1 (obese), with the average BMI being 33.5. The most common dose of duloxetine prescribed was a daily, oral dose of 60 mg. Analysis of the normalized, transformed creatinine concentrations showed that there was a significant statistical difference (P < 0.05) in the urinary duloxetine concentrations by sex and by dose (mg). Female patients further showed a statistical difference in urinary duloxetine concentration in age groups 18-64 and 64 and older. By characterizing urinary duloxetine concentrations in patients prescribed the medication, normalized distributions of data ranges have been established. These data ranges for urinary duloxetine concentrations can be used to determine patient compliance with duloxetine in routine, clinical samples.
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Affiliation(s)
- Haley A Mulder
- Department of Pharmaceutics, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA 23298, USA
| | - Greg L McIntire
- Ameritox LLC, Research and Development Department, 486 Gallimore Dairy Road, Greensboro, NC 27409, USA
| | - Frank N Wallace
- Ameritox LLC, Research and Development Department, 486 Gallimore Dairy Road, Greensboro, NC 27409, USA
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Alefan Q, Yao S, Taylor JG, Lix LM, Eurich D, Choudhry N, Blackburn DF. Factors associated with early nonpersistence among patients experiencing side effects from a new medication. J Am Pharm Assoc (2003) 2021; 62:717-726.e5. [PMID: 34980560 DOI: 10.1016/j.japh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug discontinuation (i.e., nonpersistence) is often attributed to the emergence of adverse effects. However, it is not known whether other factors increase the risk of nonpersistence when adverse effects occur. OBJECTIVES To identify factors associated with early nonpersistence among patients experiencing adverse effects from newly prescribed medications. METHODS A questionnaire was mailed to new users of antihypertensive, antihyperglycemic, and lipid-lowering medications in Saskatchewan, Canada, between 2019 and 2020. Only respondents experiencing adverse effects were included. Responses were compared between the nonpersistent group (i.e., people who had discontinued their medication) and the persistent group (i.e., those who were taking their medication at the time of the survey). Statistically significant factors were tested in multivariable logistic regression models. Odds ratios (ORs) and 95% CIs were reported. RESULTS Of the 3973 returned questionnaires, 813 respondents experienced adverse -effects from their new medication and were included in the study. Of these, 143 respondents (17.5%) had stopped their medication at the time of survey completion; most discontinuations (72.1%) occurred within 1 month of the first dose. Nonpersistent patients were older, had lower income, and were less likely to be taking an antihyperglycemic medication. After covariate adjustment, 6 factors were independently associated with nonpersistence: age less than 65 years (OR 1.56 [95% CI 1.01-2.41]), female sex (1.67 [1.08-2.59]), health condition not considered dangerous (2.09 [1.25-3.51]), medication not considered important for health (6.90 [4.40-10.84]), failure to expect adverse effects before starting medication (2.67 [1.74-4.10]), and taking 2 or more medications (0.45 [0.27-0.73]). CONCLUSION Despite the strong link between the emergence of adverse effects and early nonpersistence, our findings confirm that this association is highly influenced by several factors external to the physical experiences caused by the new medication.
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Bernauer M, Wu N, Chen SY, Peng X, Boulanger L, Zhao Y. Use of select medications prior to duloxetine initiation among commercially-insured patients. J Pain Res 2012; 5:271-8. [PMID: 23049276 PMCID: PMC3442741 DOI: 10.2147/jpr.s33438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess select medication utilization prior to duloxetine initiation among patients with major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and musculoskeletal pain associated with osteoarthritis or low back pain. METHODS Commercially insured duloxetine initiators between January 1, 2007 and March 31, 2010 were identified from a large US administrative claims database. Disease subgroups were constructed based on diagnosis from medical claims during the 12 months prior to duloxetine initiation. Prior use of antidepressants, anticonvulsants, opioids, nonsteroidal anti-inflammatory drugs, and muscle relaxants was assessed during the 12-month preinitiation period. RESULTS This study identified 56,845 (2007), 44,838 (2008), and 65,840 (January 2009 to March 2010) duloxetine initiators. Among the 2009 initiators, utilization patterns were similar for patients with major depressive disorder and generalized anxiety disorder, with antidepressants being the most used (84% and 80%, respectively), followed by opioids (58% and 55%, respectively). Patients across pain-related conditions also had similar utilization patterns, with opioid use being the highest (76%-82%), followed by antidepressants (65%-72%). Use of other medication classes was common (29%-63%) but less frequent, and over 50% of the patients used any antidepressants, 70% used any antidepressants or anticonvulsants, and 90% used any antidepressants, anticonvulsants, or opioids. Trends in the use of these select medications were similar between 2007 and 2009. CONCLUSION Patients used several types of medications over the 12 months prior to initiating duloxetine across disease states, with antidepressants and opioids being the most frequently used medications. Trends of select medication use were similar over time.
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Affiliation(s)
| | - Ning Wu
- United BioSource Corporation, Lexington, MA, USA
| | | | | | | | - Yang Zhao
- Eli Lilly and Company, Indianapolis, IN
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Wu CH, Farley JF, Gaynes BN. The association between antidepressant dosage titration and medication adherence among patients with depression. Depress Anxiety 2012; 29:506-14. [PMID: 22553149 DOI: 10.1002/da.21952] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/02/2012] [Accepted: 03/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the association between upward dose titration of antidepressants and medication adherence during the first 6 months of a newly initiated antidepressant treatment for patients with major depressive disorder (MDD). METHODS We conducted a retrospective observational cohort study using Thomson Reuters MarketScan Commercial Claims and Encounters Claims data. We identified 40,873 patients aged 18-64 with MDD newly initiating a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or bupropion between July 1, 2005 and June 30, 2007. Patients with titration (defined as antidepressant initiation at doses equal or lesser than American Psychiatric Association treatment guidelines with a dosage increase in the first 60 days of treatment) were compared to patients with no titration. Adherence was measured as the proportion of days covered (PDC) on antidepressant treatment. Patients with PDC ≥ 80% were considered adherent. Persistence was measured as the duration of time from initiation to a 30-day gap in antidepressant treatment. Multivariate logistic regression and Cox-proportional hazard models examined the influence of titration on adherence and persistence, respectively. RESULTS Adherence was greater in the titration group than in the nontitration group (67.5% versus 45.2%, P < .01). After adjustment for selected covariates, patients in the titration group were more likely to adhere to antidepressant treatments (odds ratio = 2.60, 95% confidence interval (CI) = 2.47-2.74) and less likely to have a 30-day gap in treatment (hazard ratio = 0.48, 95% CI = 0.45-0.51). CONCLUSIONS Upward dose titration on antidepressant treatments was associated with improved medication adherence and persistence. For clinicians initiating antidepressant treatment, titrating antidepressant doses may improve patient outcomes.
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Affiliation(s)
- Chung-Hsuen Wu
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7573, USA.
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Cui Z, Faries DE, Gelwicks S, Novick D, Liu X. Early discontinuation and suboptimal dosing of duloxetine treatment in patients with major depressive disorder: analysis from a US third-party payer perspective. J Med Econ 2012; 15:134-44. [PMID: 22014076 DOI: 10.3111/13696998.2011.632043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Little is known about early discontinuation of duloxetine therapy or the effect that initial dose has on discontinuation in patients with major depressive disorder (MDD). METHODS Data from a private payer insurance claim database included 6132 patients with MDD who started duloxetine between 7/1/2005 and 6/30/2006, had no prescription for duloxetine in the previous 3 months, and were enrolled for 12 months before and after initiation. Chi-square tests, t-tests, and logistic regression were used to compare demographic, clinical, and healthcare cost data stratified by length of continuation. Early discontinuation was defined as continuation ≤30 days. Healthcare costs, persistence, and adherence were compared between patients with suboptimal initial dose (<40 mg/day) and those with recommended initial dose (40-60 mg/day). RESULTS Discontinuation rates were 16.8% at ≤30 days, 16.7% at 31-90 days, 14.9% at 91-180 days, and 51.6% at >180 days. Suboptimal initial dose, younger age, male gender, prior benzodiazepine use, insomnia, psychiatric disorders, infectious diseases, digestive disorders, genitourinary disorders, and injury/poisoning increased the likelihood of early discontinuation (Odds ratios [ORs]: 1.18-2.16), while recent use of SSRIs or venlafaxine XR decreased the likelihood (ORs: 0.67-0.68). Compared with patients who persisted with therapy for >180 days, patients who discontinued early had more hospital admissions, longer hospital stays, and more ER visits during the 1-year follow-up (all p-values <0.01). Patients with an initial dose <40 mg/day had shorter persistence (p < 0.001) and lower rates of adherence (p < 0.001) compared with patients with an initial dose of 40-60 mg/day. LIMITATIONS Limitations of this study were those of all analyses based on data from insurance claim databases. CONCLUSIONS Early discontinuation was associated with increased healthcare utilization. Demographic and clinical predictors of early discontinuation were identified that may help target care for at-risk patients. Beginning therapy within the recommended dose range may improve persistence.
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Dosing Patterns for Duloxetine and Predictors of High-Dose Prescriptions in Patients With Major Depressive Disorder: Analysis from a United States Third-Party Payer Perspective. Clin Ther 2011; 33:1726-38. [DOI: 10.1016/j.clinthera.2011.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2011] [Indexed: 11/17/2022]
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Cui Z, Faries DE, Zhao Y, Novick D, Liu X. Trajectory analysis of healthcare costs for patients with major depressive disorder treated with high doses of duloxetine. J Med Econ 2011; 14:662-72. [PMID: 21892857 DOI: 10.3111/13696998.2011.611060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine healthcare cost patterns prior to and following duloxetine initiation in patients with major depressive disorder (MDD), focusing on patients initiated at or titrated to high doses. RESEARCH DESIGN AND METHODS Retrospective analysis of 10,987 outpatients, aged 18-64 years, who were enrolled in health insurance for 6 months preceding and 12 months following duloxetine initiation. OUTCOME MEASURES Repeated measures and pre-post analyses were used to examine healthcare cost trajectories before and after initiation of low- (<60 mg/day), standard- (60 mg/day), and high-dose (>60 mg/day) duloxetine therapy. Decision tree analysis was used to identify patient characteristics that might explain heterogeneity in economic outcomes following titration to high-dose therapy. RESULTS Low-, standard-, and high-dose duloxetine were initiated for 29.6%, 60.9%, and 9.5% of patients, respectively. Within 6 months, 13.7% of patients had dose increases to > 60 mg/day. Regardless of dose, total costs increased prior to and decreased following initiation of treatment. The High Initial Dose Cohort had higher costs both prior to and throughout treatment compared to the other two cohorts. Following escalation to > 60 mg/day, higher medication costs were balanced by lower inpatient costs. Titration to high-dose therapy was cost-beneficial for patients with histories of a mental disorder in addition to MDD and higher prior medical costs. LIMITATIONS Conclusions are limited by a lack of supporting clinical information and may not apply to patients who are not privately insured. CONCLUSIONS In data taken from insured patients with MDD who were started on duloxetine in a clinical setting, healthcare costs increased prior to and decreased following initiation of therapy. Compared to patients initiated at low- and standard-doses, costs were greater prior to and following initiation for patients initiated at high doses. Increases in pharmacy costs associated with escalation to high-dose therapy were offset by reduced inpatient expenses.
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