Can the Risk of Severe Depression-Related Outcomes Be Reduced by Tailoring the Antidepressant Therapy to Patient Characteristics?
Can the Risk of Severe Depression-Related Outcomes Be Reduced by Tailoring the Antidepressant Therapy to Patient Characteristics?
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DOI：
10.1093/aje/kwaa260
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发表时间：
2021-07-01
影响因子：
5
通讯作者：
Renoux, Christel
中科院分区：
文献类型：
--
作者：
Coulombe, Janie;Moodie, Erica E. M.;Renoux, Christel
选择性5-羟色胺再摄取抑制剂（SSRI）是单相抑郁症患者的一线治疗药物，但根据患者的个人特征，关于哪种SSRI对患者最有益的指导很少。在这项工作中，我们探讨是否可以使用一个个性化的治疗策略，由卫生保健提供者调整他们的处方模式，以减少严重抑郁症相关的结果（SDO）的风险时，选择西酞普兰和氟西汀，2个常用的处方SSRs。我们基于人群的队列研究使用了来自英国临床实践研究数据链、医院事件统计数据库和国家统计局数据库的数据，创建了一个1998年4月至2017年12月期间被诊断为抑郁症的患者队列，这些患者接受了西酞普兰或氟西汀治疗。从治疗开始至SDO结局发生、治疗中止或研究结束，对患者进行随访。为了找到最佳的治疗策略，我们使用动态加权生存模型，考虑患者的特征，如年龄，性别，体重指数，以前的精神病诊断和药物治疗。我们的研究结果表明，使用患者的特点，以定制的抗抑郁药物治疗与延长4天的中位时间SDO（95%置信区间：2，10天）。
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for patients with unipolar depression, yet there is little guidance on which SSRI provides the most benefit to a patient, based on personal characteristics. In this work, we explore whether an individualized treatment strategy can be used by health-care providers to adapt their prescription pattern to reduce the risk of a severe depression-related outcome (SDO) when choosing between citalopram and fluoxetine, 2 commonly prescribed SSRls. Our population-based cohort study used data from the Clinical Practice Research Datalink, the Hospital Episode Statistics repository, and the Office for National Statistics database in the United Kingdom to create a cohort of individuals diagnosed with depression who were prescribed citalopram or fluoxetine between April 1998 and December 2017. Patients were followed from treatment initiation until occurrence of the SDO outcome, treatment discontinuation, or end of study. To find an optimal treatment strategy, we used dynamic weighted survival modeling, considering patient features such as age, sex, body mass index, previous psychiatric diagnoses, and medications. Our findings suggest that using patient characteristics to tailor the antidepressant drug therapy is associated with an increase of 4 days in the median time to SDO (95% confidence interval: 2,10 days).