BACKGROUND: Many MDD patients fail to achieve remission. Current literature focuses on one major depressive episode (MDE); treatment over multiple MDEs has not been extensively explored.
OBJECTIVE: To characterize treatment patterns within and across multiple MDEs.
METHODS: Adults with newly diagnosed MDD were identified from 2009 to 2017 using IBM MarketScan Commercial databases and followed-up until lapse in continuous enrollment (12-month minimum) or study end date. MDEs began with MDD diagnosis and treatment initiation and lasted ≥6 months (possible extension by additional prescriptions). Lines of therapy (LOTs) were periods of continuous treatment and may end in treatment failure, defined as discontinuation, switching, adding an adjunctive therapy, or change in adjunctive therapy.
RESULTS: A total of 455,082 MDD patients were identified, with 52,539 patients (12%) having ≥2 MDEs. Within the first MDE, monotherapy regimens decreased from 100% to 58% by LOT4 while adjunctive therapy increased from 0% to 42%. This trend was similar for subsequent MDEs. Treatment regimens, both monotherapy and adjunctive, were consistent across MDEs. Across MDEs, >50% of patients failed treatment in each LOT with higher discontinuation and lower switching in earlier LOTs. LOT1 of MDE1 was the exception, with less discontinuation (MDE1: 36%; MDE2-4 range: 59%-66%) and higher switching (MDE1: 19%; MDE2-4 range: 4-6%).
CONCLUSION: Minimal change in MDD management and treatment failure patterns across MDEs may indicate suboptimal personalization of care. Higher discontinuation and less switching following the first MDE emphasizes the importance of early effective treatment.
This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.