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Report: Half of Drug-Treated Patients With Major Depressive Disorder Progress to Second-Line Therapies Within 1 Year of Diagnosis

Aripiprazole is leading atypical antipsychotic (November 26)

Decision Resources, a research and advisory firm for pharmaceutical and health care issues, finds that, through an analysis of U.S. longitudinal patient-level claims data, close to 50% of first-line drug-treated patients with major depressive disorder (MDD) progressed to second-line therapy within 1 year of diagnosis.

Although generic agents are largely prescribed second-line — particularly from the selective serotonin reuptake inhibitor (SSRI), dopaminergic/noradrenergic, or serotonin–norepinephrine reuptake inhibitor (SNRI) drug classes — some branded agents continue to maintain a modest patient share in later lines of therapy, the analysis shows. In particular, delayed-release duloxetine (Cymbalta, Eli Lilly) was among the top ten products used in the second line as either monotherapy or as part of a combination. This finding aligns with the practices of interviewed thought leaders, who consider duloxetine as a second- or later-line therapy after the failure of initial SSRI treatment or in patients who experience somatic symptoms of depression, such as pain and fatigue.

The report also finds that among newly diagnosed patients, the patient share for bupropion (Wellbutrin/Wellbutrin SR/Wellbutrin XL, GlaxoSmithKline/Valeant Pharmaceuticals, and generics) exceeds that of all other individual agents in the second and third lines, consistent with its use as a popular adjunctive therapy in patients with MDD who fail to respond to first-line SSRI or SNRI therapy and in patients who cannot tolerate the adverse effects of other first-line antidepressants.

Further, the report finds that the atypical antipsychotic class captured more than 14% patient share among recently treated MDD patients. Aripiprazole (Abilify, Otsuka America Pharmaceuticals) retains the largest patient share in this drug class. The U.S. approval of aripiprazole as adjunctive treatment for MDD, its lower risk of metabolic adverse effects compared with other agents, its relatively favorable market access, and what psychiatrists perceive as a more-activating side-effect profile (as opposed to the more-sedating effects of other atypical antipsychotics) give the drug an advantage in the market, the report notes.

Source: Decision Resources; November 26, 2013.

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