Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the US

Abstract: Background: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after antidepressant treatment. APA guidelines recommend clinicians modify treatment in patients who are non-responders to 4-8 weeks of treatment with the goal of remission. Objective: To assess the frequency of treatment inertia, among adult patients with MDD treated in a real-world setting. Methods: A retrospective, observational study of patients with MDD from the Decision Resources Group Real World Evidence US Data Repository (1/ 2014-6/2018) was conducted. Patients (≥18 years) who had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following ≥8weeks of stable baseline antidepressant use with/without mental-health outpatient therapy were included. Treatment inertia, modification, and discontinuation were evaluated over a 16-week follow-up period. The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: Overall, 2,850 patients (median age 55 years; 74% female) met the study criteria. Of these patients, 1,534 (54%) received treatment modification, 834 (29%) had study-defined treatment inertia, and 482 (17%) discontinued treatment. Use of mirtazapine (OR 0.63, 95% CI; 0.50-0.79), selective serotonin reuptake inhibitors (OR 0.64, 95% CI; 0.54-0.75), or bupropion (OR 0.71, 95% CI; 0.60-0.84) in the baseline period was associated with an increased likelihood of treatment modification. Conclusions: Effective symptom management is critical for optimal outcomes in patients with MDD. Results demonstrate that treatment inertia is relatively common in MDD despite guidelines recommending treatment modification in patients not reaching remission. Reference: 1. Gelenberg AJ, et al., Am J Psychiatry. 2010. 167(1).Short Description: In real-world data, we retrospectively evaluated treatment patterns among adult patients with Major Depressive Disorder who received at least 8-weeks of stable treatment but had not reached remission based on PHQ-9 score. In the 16-weeks following the elevated PHQ-9 score, 54%, 29%, and 17% of patients, respectively, modified treatment, experienced treatment inertia (defined as no change to treatment), or discontinued treatment entirely.Name of Sponsoring Organization(s): Janssen Scientific Affairs, LLC