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Odds of Second-Line Antidepressant Acceptance Vary With First-Line Treatment
For second-line antidepressant therapy overall, a medication switch within the same class as the first-line treatment generally had better odds of patient acceptance than changing to an antidepressant treatment from another class. Researchers published their findings in The Journal of Clinical Psychiatry.
“Although about half of patients do not respond to a first-line antidepressant medication, there is no consensus on the best second-line option,” the authors wrote. “The aim of this nationwide population-based study was to rank antidepressants according to their relative acceptability (ie, efficacy and tolerability) using filled prescription sequences after failure of first treatment.”
The study included 63,726 patients in the French national health data system who filled at least 2 prescriptions for a second-line antidepressant after initiating a first-line antidepressant in 2011.
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The overall adjusted odds ratio for patient acceptance, as measured by the antidepressant continuation/change ratio, was 1.23 for an intraclass switch compared with an interclass switch, according to the study.
By first-line treatment, however, the results varied. An intraclass switch was more acceptable only for patients started on selective serotonin reuptake inhibitors, the study found. The adjusted odds ratio for acceptability with an intraclass switch was 1.37. Meanwhile, combination antidepressant therapy had the greatest acceptance as a second-line treatment for patients started on tricyclic antidepressants (researchers reported a 2.53 adjusted odds ratio) or alpha-2 blockers (a 1.59 adjusted odds ratio).
There was no difference in acceptance between second-line strategies for those who initiated treatment with serotonin-norepinephrine reuptake inhibitors. Moreover, an intraclass switch had lower acceptance than an interclass switch for patients who started with other antidepressants (a 0.70 adjusted odds ratio).
“Administrative claim databases may help with ranking acceptability of second-line treatments in real-world settings and complement randomized controlled trials in informing clinicians about the most acceptable second-line options according to the first-line treatment,” researchers advised.
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