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

Junling Wang, Xianchen Liu, C. Daniel Mullins

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1303-1313
Number of pages11
JournalCurrent Medical Research and Opinion
Volume27
Issue number7
DOIs
StatePublished - Jul 1 2011

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Citalopram
Major Depressive Disorder
Chronic Pain
Therapeutics
Prescriptions
Venlafaxine Hydrochloride
Duloxetine Hydrochloride
Databases
Fibromyalgia
Selection Bias
Neurologic Manifestations
Low Back Pain
Osteoarthritis
Antidepressive Agents
Headache

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{a42af616151a409496f5946ca4c4a9b3,
title = "Treatment adherence and persistence with duloxetine, venlafaxine XR, and escitalopram among patients with major depressive disorder and chronic pain-related diseases",
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.",
author = "Junling Wang and Xianchen Liu and Mullins, {C. Daniel}",
year = "2011",
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language = "English (US)",
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pages = "1303--1313",
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issn = "0300-7995",
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TY - JOUR

T1 - Treatment adherence and persistence with duloxetine, venlafaxine XR, and escitalopram among patients with major depressive disorder and chronic pain-related diseases

AU - Wang, Junling

AU - Liu, Xianchen

AU - Mullins, C. Daniel

PY - 2011/7/1

Y1 - 2011/7/1

N2 - 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.

AB - 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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