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Orsini LS, O'Connor SJ, Mohwinckel MT, Marwood L, Pahwa AS, Bryder MN, Dong X, Levine SP. Observational study to characterize treatment-resistant depression in Germany, France and the United Kingdom: analysis of real-world data collected through a survey of healthcare professionals. Curr Med Res Opin 2022; 38:2219-2226. [PMID: 36106382 DOI: 10.1080/03007995.2022.2113692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study describes treatment patterns, productivity, healthcare resource utilization and previous episodes of depression for patients with treatment-resistant depression (TRD). METHODS In this cross-sectional study, a quantitative survey was administered to 225 healthcare providers (HCPs) distributed evenly across Germany, France and the UK from July to August 2021. Each HCP was asked to answer based on medical records of five patients with TRD, defined as patients failing to respond to two or more treatments of adequate dose and duration in the same episode of major depressive disorder (MDD), which provided a sample size of 1125 patients. RESULTS Of the 1125 patients with TRD, 73.2% had two or more previous episodes of MDD, 46.3% had a history of suicidal ideation and 24.8% had attempted suicide. Only 26.8% of patients were employed either full-time or part-time. During the most recent/current TRD episode, 45.5% of patients received five or more lines of treatment, and 46.0% remained on monotherapy. For multiple pharmacological treatments, too many distinct combinations were used to discern trends. Overall, 60.6% of patients had at least one mental health-related hospitalization in the last 12 months; 35.0% had two or more hospitalizations. Half of TRD patients saw a doctor five or more times per year for their depression. CONCLUSIONS This study addresses the knowledge gap about treatment patterns and healthcare utilization in real-world practice for TRD patients in three European countries. It provides data that potentially could inform treatment guideline development and optimize patient-perceived benefits from the treatment of TRD.
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Affiliation(s)
| | | | | | | | - Ankit S Pahwa
- ICON PLC, ICON Commercialization and Outcomes, Bangalore, India
| | - Matti N Bryder
- ICON PLC, ICON Commercialization and Outcomes, Solna, Sweden
| | - Xinzhe Dong
- ICON PLC, ICON Commercialization and Outcomes, Vancouver, Canada
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Zhao X, Karkare S, Nash AI, Sheehan JJ, Aboumrad M, Near AM, Banerji T, Joshi K. Characteristics and current standard of care among veterans with major depressive disorder in the United States: A real-world data analysis. J Affect Disord 2022; 307:184-190. [PMID: 35351492 DOI: 10.1016/j.jad.2022.03.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/04/2022] [Accepted: 03/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examined MDD treatment regimens received during the first observed and treated major depressive episode (MDE) among US veterans. METHODS This retrospective study, conducted using the Veterans Health Administration (VHA) database, supplemented with Medicare Part A/B/D data, included adults with ≥1 MDD diagnosis (index date) between 10/1/2015-2/28/2017 and ≥1 line of therapy (LOT) within the first observed complete MDE. Patient baseline (6-month pre-index) characteristics and up to six LOTs received during the first observed and treated MDE were assessed. RESULTS Of 40,240 veterans with MDD identified (mean age: 50.9 years, 83.9% male, 63.4% White, 88.6% non-Hispanic), hypertension (27.5%), hyperlipidemia (20.8%), and post-traumatic stress disorder (17.5%) were the most common baseline comorbidities. During the first observed and treated MDE, patients received a mean of 1.6 ± 1.0 LOTs, with 14.6% of patients receiving ≥3 LOTs. SSRI-monotherapy was the most commonly observed regimen in the first six LOTs, followed by SNRI-monotherapy in LOT 1 and antidepressants augmented by anticonvulsants in the remaining five LOTs. The antidepressant class of the previous LOT was commonly used in the subsequent LOT. SSRI-SSRI-SSRI was the most common LOT1-to-LOT3 sequencing pattern among patients receiving ≥3 LOTs. LIMITATIONS The study findings are limited to data in the VHA database and may not be generalizable to the non-veteran US population. CONCLUSIONS During the first observed and treated MDE, SSRI-monotherapy was the most common therapy in the first six LOTs. Cycling within SSRI class was the leading sequencing pattern of the first three LOTs among veterans who received ≥3 LOTs.
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Affiliation(s)
| | | | | | | | - Maya Aboumrad
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, Titusville, NJ, USA
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Bessa JM, Carvalho S, Cunha IB, Fernandes M, Matos-Pires A, Neves R, Oliveira-Maia AJ, Santos S, Santos V. Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts. Front Psychiatry 2022; 13:824919. [PMID: 35432028 PMCID: PMC9005774 DOI: 10.3389/fpsyt.2022.824919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
Guidance about treatment-resistant depression (TRD) in Portugal is very limited, even though depression prevalence is among the highest in European countries. A questionnaire was conducted, followed by two advisory boards with seven Portuguese psychiatry experts, to characterize and discuss MDD and TRD epidemiology, diagnosis, patient journey, treatment options, and unmet clinical needs. Consensus was reached on the main issues. In daily practice, TRD can be defined as moderate to severe MDD episodes with insufficient clinical improvement after two antidepressant treatments, taken in adequate doses and duration. TRD diagnosis and treatment are mostly decided by psychiatrists at public hospitals. Treatment type and duration must be adjusted to characteristics of the patient and the depressive episode, including symptoms, number of previous episodes, comorbidities, and previous treatment response and side effects. The most relevant objectives of TRD treatment are reaching response and remission, prevention of suicide, and improvement of quality of life, functionality, and wellbeing. Regarding pharmacotherapy, antidepressant switch occurs more frequently with non-response, while optimization, combination, and augmentation are considered for patients with partial response. Psychotherapy should be considered in parallel to pharmacological treatment. Brain stimulation techniques are underused. Lifelong treatment is required for recurrent or more chronic TRD episodes, but patient adherence is also poorer in these cases. In Portugal, TRD management is limited by lack of access to specialist care and to many treatment options. These aspects highlight that conventional pharmacotherapy does not lead to remission in many patients and that optimization strategies are frequently necessary to achieve satisfactory treatment outcomes.
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Affiliation(s)
- João M Bessa
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga and Guimarães, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga and Guimarães, Portugal.,Clinical Academic Center - Braga, Braga, Portugal
| | - Serafim Carvalho
- Department of Psychiatry, Hospital de Magalhães Lemos, Porto, Portugal
| | - Inês B Cunha
- Department of Psychiatry, Hospital Júlio de Matos - Psychiatric Hospital Centre of Lisbon, Lisbon, Portugal
| | - Milene Fernandes
- Real World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Lisbon, Portugal
| | - Ana Matos-Pires
- Department of Psychiatry, Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal.,Comprehensive Health Research Center (CHRC), NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Rui Neves
- Casa de Saúde da Idanha, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Susana Santos
- Janssen-Cilag Farmacêutica Lda, Porto Salvo, Portugal
| | - Vítor Santos
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Pilon D, Karkare S, Zhdanava M, Sheehan JJ, Côté-Sergent A, Shah A, Lopena OJ, Lefebvre P, Joshi K, Citrome L. Health care resource use, short-term disability days, and costs associated with states of persistence on antidepressant lines of therapy. J Med Econ 2021; 24:1299-1308. [PMID: 34763603 DOI: 10.1080/13696998.2021.2003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To compare health care resource utilization (HCRU), short-term disability days, and costs between states of persistence on antidepressant lines of therapy after evidence of treatment-resistant depression (TRD). METHODS Patients with major depressive disorder (MDD) were identified in the IBM MarketScan Commercial and Medicare Supplemental Databases (01/01/2013-03/04/2019), Multi-State Medicaid Database (01/01/2013-12/31/2018), and Health Productivity Management Database (01/01/2015-12/31/2018). The index date was the date of the first evidence of TRD during the first observed major depressive episode. The follow-up period was divided into 45-day increments and categorized into persistence states: (1) evaluation (first 45 days after evidence of TRD); (2) persistence on the early line after evidence of TRD; (3) persistence on a late line; and (4) non-persistence. HCRU, short-term disability days, and costs were compared between persistence states using multivariate generalized estimating equations. RESULTS Among 10,053 patients with TRD, the evaluation state was associated with higher likelihood of all-cause inpatient admissions (odds ratio [OR; 95% confidence interval (CI)] = 1.79 [1.49, 2.14]), emergency department visits (OR [95% CI] = 1.23 [1.12, 1.34]), and outpatient visits (OR [95% CI] = 3.83 [3.51, 4.18]; all p < .001) versus persistence on the early-line therapy. This resulted in $374 higher mean PPPM all-cause health care costs (95% CI = 265, 470; p < .001) during evaluation versus persistence on the early line therapy. The evaluation state was associated with 89% more short-term disability days (OR [95% CI] = 1.89 [1.49, 2.57] and $212 higher mean PPPM short-term disability costs (95% CI = 64, 259) relative to persistence on the early line (both p < .001). Moreover, during persistence on a later line, mean PPPM all-cause health care costs were $141 higher (95% CI = 13, 242; p = .028) relative to the early line. LIMITATIONS Medication may have been dispensed but not actually taken. CONCLUSIONS Higher costs during the first 45 days after evidence of the presence of TRD and during persistence on a late line relative to persistence on the early-line therapy suggest there are benefits to using more effective treatments earlier.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, USA
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Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SMI, Dzaye O, El Shahawy O, Al Rifai M, Bhatnagar A, Stokes A, Benjamin EJ, DeFilippis AP, Blaha MJ. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Netw Open 2019; 2:e1916800. [PMID: 31800073 PMCID: PMC6902792 DOI: 10.1001/jamanetworkopen.2019.16800] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. OBJECTIVE To examine the association between e-cigarette use and depression in a nationally representative sample of the adult population in the United States. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the Behavioral Risk Factor Surveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892 394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019. EXPOSURES Electronic cigarette use status defined by self-report as never, former, or current use. MAIN OUTCOMES AND MEASURES Self-reported history of a clinical diagnosis of depression. RESULTS Of the 892 394 participants (414 326 [29.0%] aged ≥60 years; 502 448 [51.3%] women), there were 28 736 (4.4%) current e-cigarette users, of whom 13 071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120 797 [24.3%] vs 10 517 [48.4%]; men, 318 970 [46.6%] vs 14 962 [60.1%]; aged 18-39 years, 129 085 [32.2%] vs 13 071 [62.1%]; current combustible cigarette use, 217 895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. CONCLUSIONS AND RELEVANCE This study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Albert D. Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. M. Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Omar El Shahawy
- Section on Tobacco, Alcohol, and Drug Use, Department of Population Health, School of Medicine, New York University, New York
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
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