Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-17T21:03:57.526Z Has data issue: false hasContentIssue false
  • English
  • Français

Increasing escitalopram dose is associated with fewer discontinuations than switch or combination approaches in patients initially on escitalopram 10mg

Published online by Cambridge University Press:  15 April 2020

T. Sanglier ,
D. Milea ,
D. Saragoussi  and
M. Toumi
T. Sanglier*
Affiliation:
International Epidemiology Department, Clinical Research and Medical Affairs, Lundbeck SAS, 43–45, quai du Président-Roosevelt, 92445Issy-les-Moulineaux, France
D. Milea
Affiliation:
International Epidemiology Department, Clinical Research and Medical Affairs, Lundbeck SAS, 43–45, quai du Président-Roosevelt, 92445Issy-les-Moulineaux, France
D. Saragoussi
Affiliation:
International Epidemiology Department, Clinical Research and Medical Affairs, Lundbeck SAS, 43–45, quai du Président-Roosevelt, 92445Issy-les-Moulineaux, France
M. Toumi
Affiliation:
Decision Sciences and Health Policy Department, Claude-Bernard University Lyon 1, 43, boulevard du 11-Novembre-1918, 68622Villeurbanne, France
*
*Corresponding author. Tel.: +33 1 79 41 29 28; fax: +33 1 79 41 29 08. E-mail address: THSA@lundbeck.com (T. Sanglier).
Get access

Abstract

Purpose

To examine the relationship between different intervention approaches and subsequent real-life outcomes in patients changing treatment from escitalopram 10mg.

Method

This was a retrospective cohort study of patients starting antidepressant treatment between 2002 and 2004. Data were extracted from a US health-insurance reimbursement claims database. Eligible patients started escitalopram 10mg and changed within 3 months to: escitalopram ≥20mg; another antidepressant; or a combination of escitalopram with another antidepressant. Medication persistence and healthcare costs over 3 months were compared between the treatment groups.

Results

Overall, 37,791 patients started escitalopram 10mg. Of the 12,830 patients (34%) who changed treatment, 56% increased escitalopram dose, 26% switched antidepressant and 18% combined escitalopram with another antidepressant. Patients in the switch and combination groups had significantly higher rates of non-persistence (56% and 91%, respectively) vs the dose-increase group (39%; both P<0.001). Combination-group patients incurred significantly greater costs vs the dose-increase group ($2805 vs $1767, respectively; P<0.001).

Conclusion

Results suggest that increasing escitalopram dose in patients responding inadequately to 10mg is associated with higher persistence rates vs the other treatment approaches. Receiving an increased dose of escitalopram was associated with significantly lower costs than combining escitalopram 10mg with another antidepressant.

Keywords

ClaimsCostsDepressionEscitalopramPersistence
Type
Original article
Information
European Psychiatry , Volume 27 , Issue 4 , May 2012 , pp. 250 - 257
Copyright
Copyright © Elsevier Masson SAS 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder: Second edition; 2000. Available at: http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=MDD2e_Inactivated_04-16-09. [Last accessed on 3 June 2009].Google Scholar
Asnis G, Tsai J, Dworak H, Mao Y. Fixed-dose comparison of escitalopram and duloxetine in severely depressed people. Presented at the 26th Biennial Congress of the Collegium Internationale Neuro-Psychopharmacologicum, Munich, Germany, 13–17 July, 2008 [Poster No. P-04.56].Google Scholar
Bull, S.A., Hunkeler, E.M., Lee, J.Y., Rowland, C.R., Williamson, T.E., Schwab, J.E.et al.Discontinuing or switching selective serotonin reuptake inhibitors. Ann Pharmacother. 2002; 36: 578–584.CrossRefGoogle ScholarPubMed
Cipriani, A., Furukawa, T.A., Salanti, G., Geddes, J.R., Higgins, J.P., Churchill, R.et al.Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009; 373: 746–758.CrossRefGoogle ScholarPubMed
Crystal, S., Sambamoorthi, U., Merzel, C.The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995; 30: 593–614.Google ScholarPubMed
Crystal, S., Sambamoorthi, U., Moynihan, P.J., McSpiritt, E.Initiation and continuation of newer antiretroviral treatments among Medicaid recipients with AIDS. J Gen Intern Med. 2001; 16: 850–859.CrossRefGoogle ScholarPubMed
Eaddy, M.T., Druss, B.G., Sarnes, M.W., Regan, T.S., Frankum, L.E.Relationship of total health care changes to selective serotonin reuptake inhibitor utilization patterns including the length of antidepressant therapy–results from a managed care administrative claims database. J Manag Care Pharm. 2005; 11: 145–150.Google ScholarPubMed
Esposito, D., Wahl, P., Daniel, G., Stoto, M.A., Erder, M.H., Croghan, T.W.Results of a retrospective claims database analysis of differences in antidepressant treatment persistence associated with escitalopram and other selective serotonin reuptake inhibitors in the United States. Clin Ther. 2009; 31: 644–656.CrossRefGoogle ScholarPubMed
Fava, M., Davidson, K.G.Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am. 1996; 19: 179–200.CrossRefGoogle ScholarPubMed
Fochtmann, L.J., Gelenberg, A.J.Guideline watch: practice guideline for the treatment of patients with major depressive disorder. Focus. 2005; 3: 34–42.CrossRefGoogle Scholar
Fredman, S.J., Fava, M., Kienke, A.S., White, C.N., Nierenberg, A.A., Rosenbaum, J.F.Partial response, nonresponse, and relapse with selective serotonin reuptake inhibitors in major depression: a survey of current next-step practices. J Clin Psychiatry. 2000; 61: 403–408.CrossRefGoogle ScholarPubMed
Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Berglund, P.A.et al.The economic burden of depression in the United States: how did it change between 1990 and 2000?. J Clin Psychiatry. 2003; 64: 1465–1475.CrossRefGoogle ScholarPubMed
Kelsey, J.E.Treatment strategies in achieving remission in major depressive disorder. Acta Psychiatr Scand. 106 suppl. 415: 2002 18–23.CrossRefGoogle Scholar
Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E.Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62: 617–627.CrossRefGoogle ScholarPubMed
Khandker, R.K., Kruzikas, D.T., McLaughlin, T.P.Pharmacy and medical costs associated with switching between venlafaxine and SSRI antidepressant therapy for the treatment of major depressive disorder. J Manag Care Pharm. 2008; 14: 426–441.Google ScholarPubMed
Kornstein, S.G., Li, D., Mao, Y., Larsson, S., Andersen, H.F., Papakostas, G.I.Escitalopram versus SNRI antidepressants in the acute treatment of major depressive disorder: integrative analysis of four double-blind, randomized clinical trials. CNS Spectr. 2009; 14: 326–333.CrossRefGoogle ScholarPubMed
Melfi, C.A., Chawla, A.J., Croghan, T.W., Hanna, M.P., Kennedy, S., Sredl, K.The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry. 1998; 55: 1128–1132.CrossRefGoogle ScholarPubMed
Mischoulon, D., Nierenberg, A.A., Kizilbash, L., Rosenbaum, J.F., Fava, M.Strategies for managing depression refractory to selective serotonin reuptake inhibitor treatment: a survey of clinicians. Can J Psychiatry. 2000; 45: 476–481.CrossRefGoogle ScholarPubMed
Owens, M.J., Knight Dl, Nemeroff, C.B.Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiatry. 2001; 50: 345–350.CrossRefGoogle ScholarPubMed
Rost, K., Nutting, P., Smith, J.L., Elliott, C.E., Dickinson, M.Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. BMJ. 2002; 325: 934.CrossRefGoogle ScholarPubMed
Rush, A.J., Trivedi, M., Carmody, T.J., Biggs, M., Shores-Wilson, K., Ibrahim, H.et al.One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies. Biol Psychiatry. 2004; 56: 46–53.CrossRefGoogle ScholarPubMed
Rush, A.J., Trivedi, M.H., Wisniewski, S.R.et al.Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006; 354: 1231–1242.CrossRefGoogle ScholarPubMed
Shergill, S.S., Katona, C.L.E.Pharmacological choices after one antidepressant fails: a survey of UK psychiatrists. J Affect Disord. 1997; 43: 19–25.CrossRefGoogle ScholarPubMed
Simon, G.E., Chisholm, D., Treglia, M., Bushnell, D. LIDO Group Course of depression, health services costs, and work productivity in an international primary care study. Gen Hosp Psychiatry. 2002; 24: 328–335.CrossRefGoogle Scholar
Simon, G., Ormel, J., Von Korff, M., Barlow, M.Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995; 152: 352–357.Google ScholarPubMed
Thompson, D., Buesching, D., Gregor, K.J., Oster, G.Patterns of antidepressant use and their relation to costs of care. Am J Manag Care. 1996; 2: 1239–1246.Google Scholar
Tournier, M., Moride, Y., Crott, R.R., du Fort, G.G., Ducruet, T.Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population. J Affect Disord. 2009; 115: 160–166.CrossRefGoogle ScholarPubMed
Trivedi, M.H., Rush, A.J., Wisniewski, S.R., Nierenberg, A.A., Warden, D., Ritz, L.et al.Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006; 163: 28–40.CrossRefGoogle ScholarPubMed
Turner, B.J., Newschaffer, C.J., Zhang, D., Cosler, L., Hauck, W.W.Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Med Care. 2000; 38: 911–925.CrossRefGoogle ScholarPubMed
Wade, A.G., Schlaepfer, T.E., Andersen, H.F., Kilts, C.D.Clinical milestones predict symptom remission over 6-months and choice of treatment of patients with major depressive disorder (MDD). J Psychiatr Res. 2009; 43: 568–575.CrossRefGoogle ScholarPubMed
Warden, D., Rush, A.J., Trivedi, M.H., Fava, M., Wisniewski, S.R.The STAR*D project results: a comprehensive review of findings. Curr Psychiatry Rep. 2007; 9: 449–459.CrossRefGoogle Scholar
Wu EQ, Yu AP, Buessing M, Ben-Hamadi R, Tang J, Seale J, et al. Health care resource utilization and costs comparison for MDD patients on 10mg escitalopram who increased to 20mg dose versus those who were switched to SNRI. Presented at the International Society for Pharmacoeconomics and Outcomes Research 13th Annual International Meeting, Toronto, Ontario, Canada, 3–7 May, 2008 [Poster No. PMH44].CrossRefGoogle Scholar
Zimmerman, M., Posternak, M., Friedman, M., Atiullah, N., Baymiller, S., Boland, R.et al.Which factors influence psychiatrists’ selection of antidepressants?. Am J Psychiatry. 2004; 161: 1285–1289.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.