Prescription patterns following first-line new generation antidepressants for depression in Japan: A naturalistic cohort study based on a large claims database
Prescription patterns following first-line new generation antidepressants for depression in Japan: A naturalistic cohort study based on a large claims database
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DOI：
10.1016/j.jad.2013.05.015
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发表时间：
2013-09-25
影响因子：
6.6
通讯作者：
Kawakami, Koji
中科院分区：
文献类型：
--
作者：
Furukawa, Toshi A.;Onishi, Yoshie;Kawakami, Koji
背景资料：几项研究已经描述了现实世界的一线抗抑郁药的处方模式，但很少有人知道他们的命运在持续时间，强度和changes.Methods：一个初始队列的新发病的非精神病性抑郁症开始抗抑郁治疗的新一代抗抑郁药在2009年和2010年之间在日本的一个大型健康保险索赔数据库。一线抗抑郁药的持续时间和强度，二线抗抑郁药的时间和种类，以及抗抑郁治疗的总持续时间进行了examined.Results：我们确定了1592例患者。一线药物达到的起始剂量和最大剂量似乎与指南建议基本一致，尽管后者倾向于推荐范围的最小值。一线抗抑郁药的持续性远远低于指南建议，28%的患者在首次处方后从未返回，55%的患者在3个月内退出。在所有一线抗抑郁药中，14%随后被另一种精神药物增强，而17%分别在中位数3或2个月后改用另一种抗抑郁药。二线代理商的选择差别极大。抗抑郁药治疗的总持续时间最短，中位数为4个月，68%的人在6个月内停止治疗。局限性：索赔数据库分析中非精神病性单相抑郁症的诊断仍然是近似的。结论：当前指南与临床现实严重脱节。一方面，指南需要反映现实世界的实践：另一方面，临床医生应该限制他们的治疗选择，并允许基于证据的比较有效性研究，以便患者不再被给予不太有效和更有效的治疗，而无法区分它们。(C)2013爱思唯尔有限公司版权所有。
Background: Several studies have described real-world prescription patterns of first-line antidepressants for depression but little is known about their fate in terms of duration, intensity and changes.Methods: An inception cohort of new onset non-psychotic depression initiating antidepressant treatment with a new generation antidpressive agent was identified in a large health insurance claims database in japan between 2009 and 2010. The duration and intensity of first-line antidepressants, the timing and kind of second-line antidepressants and the total duration of antidepressant treatment were examined.Results: We identified 1592 patients. The starting dose and the maximum dose attained with the first-line agent appeared to be largely in line with the guideline recommendations although the latter tended toward the minimum of the recommended range. The continuity of the first-line antidepressant was far below the guideline recommendations, with 28% never returning after the initial prescription and 55% dropping out within 3 months. Of all the first-line antidepressants, 14% were subsequently augmented by another psychotropic agent while 17% were switched to another antidepressant after a median of 3 or 2 months, respectively. The choice of the second-line agents varied extremely widely. The total duration of antidepressant therapy was as short as a median of 4 months, with 68% stopping treatment by 6 months.Limitations: The diagnosis of non-psychotic unipolar depression in the claims database analyses remains approximate.Conclusions: The current guidelines are grossly out of touch with the clinical realities. On the one hand, guidelines need to reflect the real-world practices: on the other hand clinicians should limit their treatment options and allow evidence-based comparative effectiveness research among them so that patients shall no longer be given less effective and more effective treatments without being able to distinguish among them. (C) 2013 Elsevier B.V. All rights reserved.