Treatment adherence and persistence with duloxetine, venlafaxine XR, and escitalopram among patients with major depressive disorder and chronic pain-related diseases

Author: Wang Junling   Liu Xianchen   Mullins C. Daniel  

Publisher: Informa Healthcare

ISSN: 1473-4877

Source: Current Medical Research and Opinion, Vol.27, Iss.7, 2011-07, pp. : 1303-1313

Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.

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Abstract

Abstract Objective:Chronic pain is prevalent in patients with major depressive disorder (MDD). This study compared adherence and persistence rates among MDD patients with comorbid chronic pain-related diseases (CPD, including fibromyalgia, diabetes with neurological manifestations, osteoarthritis, low back pain, and headache) for three antidepressants: duloxetine, venlafaxine XR, and escitalopram. Research design and methods:A retrospective analysis was conducted of 15,523 adult MDD patients with CPD in the MarketScan Commercial Claims and Encounters Database who started on one of the study medications between 07/01/06 and 06/30/07. Patients were followed-up for 6 months. Adherence was reported using a medication possession ratio ≥≥0.8. Persistence was measured using persistence rates (proportions of patients who continuously refilled prescriptions during 6 months) and duration of therapy (number of days patients remained on the study medication before a prescription gap over 30 days). Multivariate logistic regression on adherence and persistence rates and linear regression on duration of therapy adjusting for patient and prescription characteristics were conducted. Results:Patients on duloxetine had a higher adherence rate (46.03%%) than those on venlafaxine XR (42.94%%; p == 0.0033) or escitalopram (37.27%%; p < 0.0001). Patients on duloxetine also had a higher persistence rate and longer duration of therapy (43.66%%, 117.82 days) than did patients treated with venlafaxine XR (40.38%%; p == 0.0017; 114.24 days; p == 0.009) or escitalopram (33.86%%; p < 0.0001; 105.73 days; p < 0.0001). These differences were still significant after adjusting for patient and prescription characteristics (p < 0.05). Sensitivity analyses found similar patterns using an allowable gap for refill of 15 days. Conclusions:Among commercially insured MDD patients with CPD, duloxetine-treated patients had higher adherence and persistence rates than did patients treated with venlafaxine XR or escitalopram during 6 months after medication initiation. Future studies should examine the clinical and economic implications of these differences. Limitations:This study has limitations such as possible selection bias using secondary database analysis.

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