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Antidepressant medication treatment patterns in Asian patients with major depressive disorder.

Novick D, Montgomery W, Moneta V, Peng X, Brugnoli R, Haro JM - Patient Prefer Adherence (2015)

Bottom Line: In those patients who had an adequate response, age and country were significantly associated with time to medication discontinuation.At 3 months, nonadherent patients had significantly higher disease severity (CGI-S, P=0.0001; HAMD-17, P<0.0001), lower QoL ratings (EQ-5D tariff, P=0.0007; EQ-5D visual analog scale, P=0.0024), and lower response and remission rates (both P<0.0001) compared with adherent patients.Nonadherent patients had significantly higher disease severity, lower QoL ratings, and lower response and remission rates compared with adherent patients.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly and Company, Windlesham, Surrey, UK.

ABSTRACT

Purpose: To describe pharmacological treatment patterns in Asian patients with major depressive disorder (MDD), including duration of treatment, reasons for medication discontinuation, rate of medication nonadherence, factors associated with medication nonadherence, and impact of medication nonadherence on depression outcomes.

Patients and methods: Data were from a prospective, observational 3-month study of East Asian MDD inpatients from 40 sites in six East Asian countries who initiated antidepressant treatment at baseline (n=569). Assessments included the Clinical Global Impression-Severity scale (CGI-S), 17-item Hamilton Depression Rating Scale (HAMD-17), painful physical symptoms, response and remission, employment status, quality of life (QoL) (EuroQOL Questionnaire-5 Dimensions [EQ-5D]) and health state using the visual analog scale, adherence by clinician opinion, and patient self-report. Cox proportional hazards modeling, Kaplan-Meier survival analysis, and regression modeling were employed.

Results: Median time to discontinuation for any reason was 70 days (95% confidence interval: 47; 95). Reasons for discontinuation were inadequate response in 64.1%, nonadherence in 6.2%, and adverse events in 4.1%; 25.6% who discontinued experienced an adequate response to treatment. In those patients who had an adequate response, age and country were significantly associated with time to medication discontinuation. Patient-reported nonadherence was 57.5% and clinician-reported nonadherence was 14.6% (62/426). At 3 months, nonadherent patients had significantly higher disease severity (CGI-S, P=0.0001; HAMD-17, P<0.0001), lower QoL ratings (EQ-5D tariff, P=0.0007; EQ-5D visual analog scale, P=0.0024), and lower response and remission rates (both P<0.0001) compared with adherent patients. The odds of response and remission were greater among adherent patients.

Conclusion: Early discontinuation of antidepressants among Asian MDD patients was high. A total of 25.6% who discontinued prematurely were experiencing an adequate response to treatment. Nonadherent patients had significantly higher disease severity, lower QoL ratings, and lower response and remission rates compared with adherent patients.

No MeSH data available.


Related in: MedlinePlus

Time to antidepressant medication discontinuation (n=430).
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f1-ppa-9-421: Time to antidepressant medication discontinuation (n=430).

Mentions: Mean (standard deviation [SD]) age of the 430 patients was 46.25 (SD 14.00) years and 67.4% were women. Time to medication discontinuation among the 430 patients for whom both baseline and 3-month assessments were available is shown in Figure 1. The rate of medication discontinuation was rapid during the first 10 days, and then slowed thereafter; 242 (56.3%) patients had discontinued their medication by 3 months, and 188 (43.7%) continued treatment. The median time to discontinuation for any reason was 70 days (95% confidence interval [CI]: 47; 95). Among the 242 patients who discontinued treatment, the reasons for discontinuation were inadequate response to treatment in 155 (64.1%) patients, nonadherence in 15 (6.2%) patients, and adverse events in ten (4.1%) patients; 62 (25.6%) patients who discontinued experienced an adequate response to treatment. Among the patients experiencing an adequate response to treatment, mean (SD) time to discontinuation was 48.7 (40.1) days, with a median time to discontinuation of 47.5 days. Among the patients experiencing an inadequate response, mean (SD) time to discontinuation was 20.5 (SD 21.1) days, with a median time to discontinuation of 13 days.


Antidepressant medication treatment patterns in Asian patients with major depressive disorder.

Novick D, Montgomery W, Moneta V, Peng X, Brugnoli R, Haro JM - Patient Prefer Adherence (2015)

Time to antidepressant medication discontinuation (n=430).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4362981&req=5

f1-ppa-9-421: Time to antidepressant medication discontinuation (n=430).
Mentions: Mean (standard deviation [SD]) age of the 430 patients was 46.25 (SD 14.00) years and 67.4% were women. Time to medication discontinuation among the 430 patients for whom both baseline and 3-month assessments were available is shown in Figure 1. The rate of medication discontinuation was rapid during the first 10 days, and then slowed thereafter; 242 (56.3%) patients had discontinued their medication by 3 months, and 188 (43.7%) continued treatment. The median time to discontinuation for any reason was 70 days (95% confidence interval [CI]: 47; 95). Among the 242 patients who discontinued treatment, the reasons for discontinuation were inadequate response to treatment in 155 (64.1%) patients, nonadherence in 15 (6.2%) patients, and adverse events in ten (4.1%) patients; 62 (25.6%) patients who discontinued experienced an adequate response to treatment. Among the patients experiencing an adequate response to treatment, mean (SD) time to discontinuation was 48.7 (40.1) days, with a median time to discontinuation of 47.5 days. Among the patients experiencing an inadequate response, mean (SD) time to discontinuation was 20.5 (SD 21.1) days, with a median time to discontinuation of 13 days.

Bottom Line: In those patients who had an adequate response, age and country were significantly associated with time to medication discontinuation.At 3 months, nonadherent patients had significantly higher disease severity (CGI-S, P=0.0001; HAMD-17, P<0.0001), lower QoL ratings (EQ-5D tariff, P=0.0007; EQ-5D visual analog scale, P=0.0024), and lower response and remission rates (both P<0.0001) compared with adherent patients.Nonadherent patients had significantly higher disease severity, lower QoL ratings, and lower response and remission rates compared with adherent patients.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly and Company, Windlesham, Surrey, UK.

ABSTRACT

Purpose: To describe pharmacological treatment patterns in Asian patients with major depressive disorder (MDD), including duration of treatment, reasons for medication discontinuation, rate of medication nonadherence, factors associated with medication nonadherence, and impact of medication nonadherence on depression outcomes.

Patients and methods: Data were from a prospective, observational 3-month study of East Asian MDD inpatients from 40 sites in six East Asian countries who initiated antidepressant treatment at baseline (n=569). Assessments included the Clinical Global Impression-Severity scale (CGI-S), 17-item Hamilton Depression Rating Scale (HAMD-17), painful physical symptoms, response and remission, employment status, quality of life (QoL) (EuroQOL Questionnaire-5 Dimensions [EQ-5D]) and health state using the visual analog scale, adherence by clinician opinion, and patient self-report. Cox proportional hazards modeling, Kaplan-Meier survival analysis, and regression modeling were employed.

Results: Median time to discontinuation for any reason was 70 days (95% confidence interval: 47; 95). Reasons for discontinuation were inadequate response in 64.1%, nonadherence in 6.2%, and adverse events in 4.1%; 25.6% who discontinued experienced an adequate response to treatment. In those patients who had an adequate response, age and country were significantly associated with time to medication discontinuation. Patient-reported nonadherence was 57.5% and clinician-reported nonadherence was 14.6% (62/426). At 3 months, nonadherent patients had significantly higher disease severity (CGI-S, P=0.0001; HAMD-17, P<0.0001), lower QoL ratings (EQ-5D tariff, P=0.0007; EQ-5D visual analog scale, P=0.0024), and lower response and remission rates (both P<0.0001) compared with adherent patients. The odds of response and remission were greater among adherent patients.

Conclusion: Early discontinuation of antidepressants among Asian MDD patients was high. A total of 25.6% who discontinued prematurely were experiencing an adequate response to treatment. Nonadherent patients had significantly higher disease severity, lower QoL ratings, and lower response and remission rates compared with adherent patients.

No MeSH data available.


Related in: MedlinePlus