Major Depression
Conditions
Brief summary
The primary purpose of this study is to investigate medication utilization pattern and risk of adverse outcomes among commonly used antidepressants by using nationwide claims database, in order to assess overall clinical benefit of antidepressant therapy in real-world practice.
Detailed description
While there are many antidepressants from which physicians can select based on efficacy and tolerability profile, evidence on effectiveness and safety outcomes of new antidepressants in real clinical practice among Korean MDD population is limited. Hence, this study will explore the following primary, secondary objectives using national health insurance database : 1. Explore baseline characteristics and drug utilization patterns of 11 commonly used antidepressant therapy during 90 days of acute treatment phase 2. Explore drug utilization patterns such as therapy changes, medication compliance and recurrence relationship, and risk of adverse outcomes during maintenance phase 3. Choice of antidepressants and drug utilization patterns in patients with various comorbidities 4. The relationship of non-pharmacologic treatment and discontinuation, medication compliance 5. Choice of antidepressants by non-psychiatric specialty
Interventions
DRUGEscitalopram
Treatment for depression
DRUGParoxetine
Treatment for depression
DRUGFluoxetine
Treatment for depression
DRUGMirtazapine
Treatment for depression
DRUGDuloxetine
Treatment for depression
DRUGSertraline
Treatment for depression
DRUGVenlafaxine
Treatment for depression
DRUGTianeptine
Treatment for depression
DRUGVortioxetine
Treatment for depression
DRUGDesvenlafaxine
Treatment for depression
DRUGBupropion
Treatment for depression
Sponsors
Pfizer
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients must meet all of the following inclusion criteria to be eligible for inclusion in the study: 1. Patients aged 18 years or older on the index date 2. Patients who had at least one inpatient claim or two outpatient claims in the intake period with any of the following diagnosis codes F06.3 Organic mood \[affective\] disorders F32\* Depressive episode F33\* Recurrent depressive disorder F34.1 Neurotic depression F38.1 Other recurrent mood \[affective\] disorder F41.2 Mixed anxiety and depressive disorder 3. Patients prescribed any of the following antidepressant during intake period (from January 1, 2017 to June 30, 2018)
Exclusion criteria
Patients meeting any of the following criteria will not be included in the study: 1. Patients with a claim of diagnosis codes in Table 1 during the 12 month pre-index period 2. Patients with a claim of prescription in Table 2 during the 12 month pre-index period 3. Patient who had a claim as a beneficiary of Medical Aid program (Korean Medicaid program with free or minimum copay) 4. Patients who are hospitalized at the index date 5. Patients who are under hospice care (procedure codes WG\*-WO\*)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average Daily Dosage During the Acute Treatment Phase | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively) | Acute treatment phase was during the first 90-day period starting from the index date. |
| Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively) | Percentage of prescriptions for commonly used antidepressants in acute treatment phase were assessed. Acute treatment phase was during the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period. |
| Average Daily Dosage at Index Date | At index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively) | Index date was the first prescription date of study treatment during the intake period. |
| Medication Possession Ratio (MPR) During First 180 Days of Treatment | From index date (anytime between 01-Jan-2018 to 31-Dec-2019) up to 180 days of treatment (data collected and observed retrospectively) | MPR= Days of medication possession from the prescriptions filled in the 180 days divided by (180 days plus + extra days of drug supply from the last prescription fill during the 180 days). MPR by each index drug including escitalopram, paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, venlafaxine, tianeptine, vortioxetine, desvenlafaxine and bupropion is reported in this outcome measure. Index date was first prescription date of study drugs during intake period. |
| Persistence During First 180 Days of Treatment | From index date (anytime between 01-Jan-2018 to 31-Dec-2019) up to 180 days of treatment (data collected and observed retrospectively) | Persistence was defined as the average length of treatment on the index drugs (escitalopram, paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, venlafaxine, tianeptine, vortioxetine, desvenlafaxine and bupropion), allowing 14-day permissible gap. Index date was first prescription date of study drugs during intake period. |
| Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively) | Percentage of participants who discontinued the treatment in first 90 days from the index date is reported in this outcome measure. Index date was the first prescription date of study treatment during the intake period. |
| Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 180 days of treatment (data collected and observed retrospectively) | Adherence was defined when MPR \>= 75%. MPR = (Days of medication possession from the prescriptions filled in the 180 days) / (180 days + extra days of drug supply from the last prescription fill during the 180 days. Index date was the first prescription date of study drugs during the intake period. |
| Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively) | Recurrence during the acute treatment phase was defined as either one of the following: 1) Inpatient episode with a diagnosis code. 2) Inpatient episodes via the department of psychiatry or emergency medicine. 3) Inpatient episode via nursing hospital. 4) Emergency room visit with a diagnosis code. 5) Suicide attempt. Acute phase considered as the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period. Diagnosis codes used for inclusion were: F06.3-Organic mood(affective) disorders, F32\*- Depressive episode, F33\*- Recurrent depressive disorder, F34.1- Neurotic depression, F38.1- Other recurrent mood(affective) disorders, F41.2- Mixed anxiety and depressive disorder. |
| Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | From day 91 to day 180 from the index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively) | Recurrence was defined as either one of the following: 1) Inpatient episode with a diagnosis code. 2) Inpatient episodes via the department of psychiatry or emergency medicine. 3) Inpatient episode via nursing hospital. 4) Emergency room visit with a diagnosis code. 5) Suicide attempt; antidepressant prescription after 30 days of drug holiday. Acute phase considered as the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period. |
| Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | From 91 up to 180 days of treatment from index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively) | An AE was any untoward medical occurrence that did not necessarily have a causal relationship with study treatment. Maintenance phase was during the second 90-day period (91 to 180 days) starting from the index date. Index date was the first prescription date of study treatment during the intake period. Index date was the first prescription date of study treatment during the intake period. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Drug Utilization Pattern of Participants During 90-180 Days of Treatment | From 90 days to 180 days of treatment (data collected and observed retrospectively) | The drug utilization pattern is presented according to the average treatment duration for each antidepressant during the maintenance treatment phases. |
| Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively) | Percentage of participants who received monotherapy, combination therapy and augmentation therapy during 90 days of treatment were assessed in this outcome measure. Acute treatment phase was during initial 90 days from the index date. |
Countries
South Korea
Participant flow
Recruitment details
Participants who initiated antidepressants between 01-Jan-2018 to 30-Jun-2019 in Health Insurance Review and Assessment (HIRA) service database were observed in this retrospective study. Index date was first prescription date of study drugs during intake period (01-Jan-2018 to 31-Dec-2019). Acute phase was initial 90 days of treatment period and maintenance phase was from 91 to 180 days of treatment. Participants were followed up until 31-Dec-2020.
Pre-assignment details
A total of 370212 participants were included in the study.
Participants by arm
| Arm | Count |
|---|---|
| Participants With Antidepressant Therapy Participants who initiated antidepressant therapy (escitalopram, paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, venlafaxine, tianeptine, vortioxetine, desvenlafaxine and bupropion) between 01-Jan-2018 to 30-Jun-2019 in the HIRA database were included and observed. | 370,212 |
| Total | 370,212 |
Baseline characteristics
| Characteristic | Participants With Antidepressant Therapy | — |
|---|---|---|
| Age, Continuous | 41.51 Years STANDARD_DEVIATION 15.1 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 223994 Participants | — |
| Sex: Female, Male Male | 146218 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Average Daily Dosage at Index Date
Index date was the first prescription date of study treatment during the intake period.
Time frame: At index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018, to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Escitalopram | 6.34 Milligrams per day | Standard Deviation 3.23 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Paroxetine | 13.01 Milligrams per day | Standard Deviation 5.5 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Fluoxetine | 16.30 Milligrams per day | Standard Deviation 8.55 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Sertraline | 38.75 Milligrams per day | Standard Deviation 19.56 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Duloxetine | 34.80 Milligrams per day | Standard Deviation 12.91 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Venlafaxine | 54.11 Milligrams per day | Standard Deviation 29.12 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Desvenlafaxine | 51.91 Milligrams per day | Standard Deviation 11.32 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Mirtazapine | 8.71 Milligrams per day | Standard Deviation 5.56 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Tianeptine | 24.28 Milligrams per day | Standard Deviation 9.24 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Vortioxetine | 6.03 Milligrams per day | Standard Deviation 2.62 |
| Participants With Antidepressant Therapy | Average Daily Dosage at Index Date | Bupropion | 152.97 Milligrams per day | Standard Deviation 53.43 |
Primary
Average Daily Dosage During the Acute Treatment Phase
Acute treatment phase was during the first 90-day period starting from the index date.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Overall Number of Participants Analyzed' signifies number of participants who were treated with monotherapy and 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Escitalopram | 7.94 Milligrams per day | Standard Deviation 4.13 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Paroxetine | 15.27 Milligrams per day | Standard Deviation 7.48 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Fluoxetine | 19.07 Milligrams per day | Standard Deviation 10.34 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Sertraline | 49.91 Milligrams per day | Standard Deviation 30.24 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Duloxetine | 37.51 Milligrams per day | Standard Deviation 16.62 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Venlafaxine | 69.12 Milligrams per day | Standard Deviation 39.98 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Desvenlafaxine | 63.22 Milligrams per day | Standard Deviation 26.91 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Mirtazapine | 10.46 Milligrams per day | Standard Deviation 7.15 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Tianeptine | 21.71 Milligrams per day | Standard Deviation 9.85 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Vortioxetine | 8.26 Milligrams per day | Standard Deviation 3.95 |
| Participants With Antidepressant Therapy | Average Daily Dosage During the Acute Treatment Phase | Bupropion | 162.75 Milligrams per day | Standard Deviation 67.75 |
Primary
Medication Possession Ratio (MPR) During First 180 Days of Treatment
MPR= Days of medication possession from the prescriptions filled in the 180 days divided by (180 days plus + extra days of drug supply from the last prescription fill during the 180 days). MPR by each index drug including escitalopram, paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, venlafaxine, tianeptine, vortioxetine, desvenlafaxine and bupropion is reported in this outcome measure. Index date was first prescription date of study drugs during intake period.
Time frame: From index date (anytime between 01-Jan-2018 to 31-Dec-2019) up to 180 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Escitalopram | 0.47 Ratio | Standard Deviation 0.35 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Paroxetine | 0.49 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Fluoxetine | 0.46 Ratio | Standard Deviation 0.34 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Sertraline | 0.48 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Duloxetine | 0.47 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Venlafaxine | 0.50 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Desvenlafaxine | 0.53 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Mirtazapine | 0.47 Ratio | Standard Deviation 0.36 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Tianeptine | 0.39 Ratio | Standard Deviation 0.33 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Vortioxetine | 0.50 Ratio | Standard Deviation 0.35 |
| Participants With Antidepressant Therapy | Medication Possession Ratio (MPR) During First 180 Days of Treatment | Bupropion | 0.45 Ratio | Standard Deviation 0.34 |
Primary
Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase
Recurrence was defined as either one of the following: 1) Inpatient episode with a diagnosis code. 2) Inpatient episodes via the department of psychiatry or emergency medicine. 3) Inpatient episode via nursing hospital. 4) Emergency room visit with a diagnosis code. 5) Suicide attempt; antidepressant prescription after 30 days of drug holiday. Acute phase considered as the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period.
Time frame: From day 91 to day 180 from the index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Escitalopram | 22.71 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Paroxetine | 23.58 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Fluoxetine | 23.74 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Sertraline | 22.91 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Duloxetine | 25.48 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Venlafaxine | 23.36 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Desvenlafaxine | 23.81 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Mirtazapine | 24.64 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Tianeptine | 27.80 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Vortioxetine | 22 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence After the Acute Treatment Phase | Bupropion | 21.85 Percentage of participants |
Primary
Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase
Recurrence during the acute treatment phase was defined as either one of the following: 1) Inpatient episode with a diagnosis code. 2) Inpatient episodes via the department of psychiatry or emergency medicine. 3) Inpatient episode via nursing hospital. 4) Emergency room visit with a diagnosis code. 5) Suicide attempt. Acute phase considered as the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period. Diagnosis codes used for inclusion were: F06.3-Organic mood(affective) disorders, F32\*- Depressive episode, F33\*- Recurrent depressive disorder, F34.1- Neurotic depression, F38.1- Other recurrent mood(affective) disorders, F41.2- Mixed anxiety and depressive disorder.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Escitalopram | 16.42 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Paroxetine | 17.84 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Fluoxetine | 15.64 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Sertraline | 16.73 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Duloxetine | 17.97 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Venlafaxine | 17.73 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Desvenlafaxine | 20.85 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Mirtazapine | 19.51 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Tianeptine | 16.34 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Vortioxetine | 17.62 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Experiencing Recurrence During the Acute Treatment Phase | Bupropion | 16.13 Percentage of participants |
Primary
Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%])
Adherence was defined when MPR \>= 75%. MPR = (Days of medication possession from the prescriptions filled in the 180 days) / (180 days + extra days of drug supply from the last prescription fill during the 180 days. Index date was the first prescription date of study drugs during the intake period.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 180 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Escitalopram | 30.31 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Paroxetine | 33.18 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Fluoxetine | 27.92 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Sertraline | 31.48 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Duloxetine | 30.73 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Venlafaxine | 33.39 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Desvenlafaxine | 37.20 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Mirtazapine | 30.32 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Tianeptine | 20.75 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Vortioxetine | 32.51 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Adhered to Treatment Measured by MPR (More Than or Equal to [>=] 75 Percent [%]) | Bupropion | 27.16 Percentage of participants |
Primary
Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date
Percentage of participants who discontinued the treatment in first 90 days from the index date is reported in this outcome measure. Index date was the first prescription date of study treatment during the intake period.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Escitalopram | 14.82 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Paroxetine | 15.16 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Fluoxetine | 15.14 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Sertraline | 14.87 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Duloxetine | 17.04 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Venlafaxine | 14.04 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Desvenlafaxine | 12.81 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Mirtazapine | 15.21 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Tianeptine | 22.27 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Vortioxetine | 12.94 Percentage of participants |
| Participants With Antidepressant Therapy | Percentage of Participants Who Discontinued Treatment in the First 90 Days From the Index Date | Bupropion | 14.34 Percentage of participants |
Primary
Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment
An AE was any untoward medical occurrence that did not necessarily have a causal relationship with study treatment. Maintenance phase was during the second 90-day period (91 to 180 days) starting from the index date. Index date was the first prescription date of study treatment during the intake period. Index date was the first prescription date of study treatment during the intake period.
Time frame: From 91 up to 180 days of treatment from index date (anytime between 01-Jan-2018 to 30-Jun-2019) (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Escitalopram | 6.08 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Paroxetine | 6.44 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Fluoxetine | 4.29 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Sertraline | 6.09 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Duloxetine | 9.59 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Venlafaxine | 6.48 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Desvenlafaxine | 7.50 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Mirtazapine | 10.36 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Tianeptine | 8.66 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Vortioxetine | 5.34 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants With Adverse Events (AE) Within Maintenance Phase of Treatment | Bupropion | 4.68 Percentage of Participants |
Primary
Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase
Percentage of prescriptions for commonly used antidepressants in acute treatment phase were assessed. Acute treatment phase was during the first 90-day period starting from the index date. Index date was the first prescription date of study treatment during the intake period.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Escitalopram | 44.19 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Paroxetine | 10.1 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Fluoxetine | 12.15 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Sertraline | 8.89 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Duloxetine | 2.3 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Venlafaxine | 3.21 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Desvenlafaxine | 1.75 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Mirtazapine | 4.1 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Tianeptine | 5.52 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Vortioxetine | 4.81 Percentage of prescriptions |
| Participants With Antidepressant Therapy | Percentage of Prescriptions for Commonly Used Antidepressants in Acute Treatment Phase | Bupropion | 2.88 Percentage of prescriptions |
Primary
Persistence During First 180 Days of Treatment
Persistence was defined as the average length of treatment on the index drugs (escitalopram, paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, venlafaxine, tianeptine, vortioxetine, desvenlafaxine and bupropion), allowing 14-day permissible gap. Index date was first prescription date of study drugs during intake period.
Time frame: From index date (anytime between 01-Jan-2018 to 31-Dec-2019) up to 180 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Escitalopram | 76.11 Days | Standard Deviation 67.04 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Paroxetine | 79.83 Days | Standard Deviation 68.43 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Fluoxetine | 74.17 Days | Standard Deviation 65.32 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Sertraline | 77.34 Days | Standard Deviation 67.64 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Duloxetine | 71.66 Days | Standard Deviation 67.64 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Venlafaxine | 79.80 Days | Standard Deviation 68.79 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Desvenlafaxine | 87.13 Days | Standard Deviation 68.81 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Mirtazapine | 73.12 Days | Standard Deviation 66.78 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Tianeptine | 54.48 Days | Standard Deviation 60.14 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Vortioxetine | 81.44 Days | Standard Deviation 66.5 |
| Participants With Antidepressant Therapy | Persistence During First 180 Days of Treatment | Bupropion | 71.96 Days | Standard Deviation 63.82 |
Other Pre-specified
Drug Utilization Pattern of Participants During 90-180 Days of Treatment
The drug utilization pattern is presented according to the average treatment duration for each antidepressant during the maintenance treatment phases.
Time frame: From 90 days to 180 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Number Analyzed' signifies participants evaluable for the specified rows.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Escitalopram | 59.05 Days | Standard Deviation 27.21 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Paroxetine | 60.50 Days | Standard Deviation 26.73 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Fluoxetine | 56.07 Days | Standard Deviation 27.3 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Sertraline | 59.58 Days | Standard Deviation 26.95 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Duloxetine | 59.25 Days | Standard Deviation 27.64 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Venlafaxine | 61.17 Days | Standard Deviation 26.61 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Desvenlafaxine | 63.65 Days | Standard Deviation 26.05 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Mirtazapine | 60.92 Days | Standard Deviation 27.17 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Tianeptine | 51.93 Days | Standard Deviation 29.53 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Vortioxetine | 60.91 Days | Standard Deviation 26.4 |
| Participants With Antidepressant Therapy | Drug Utilization Pattern of Participants During 90-180 Days of Treatment | Bupropion | 57.34 Days | Standard Deviation 27.18 |
Other Pre-specified
Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase
Percentage of participants who received monotherapy, combination therapy and augmentation therapy during 90 days of treatment were assessed in this outcome measure. Acute treatment phase was during initial 90 days from the index date.
Time frame: From the index date (anytime between 01-Jan-2018 to 30-Jun-2019) up to 90 days of treatment (data collected and observed retrospectively)
Population: FAS included participants who had newly initiated antidepressant therapies between 01-Jan-2018 to 30-Jun-2019, in the HIRA database. Here, 'Overall Number of Participants Analyzed' signifies number of participants evaluable for this outcome measure and 'Number Analyzed' signifies participants evaluable for the specified rows. One participant was evaluable for more than one row.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Escitalopram | 78.92 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Escitalopram | 8.91 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: escitalopram | 14.01 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Paroxetine | 73.10 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Paroxetine | 10.91 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: paroxetine | 15.18 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Fluoxetine | 74.65 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Fluoxetine | 10.08 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: fluoxetine | 13.52 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Sertraline | 74.36 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Sertraline | 9.37 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: sertraline | 14.16 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Duloxetine | 68.91 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Duloxetine | 12.53 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: duloxetine | 14.31 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Venlafaxine | 67.58 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Venlafaxine | 13.11 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: venlafaxine | 14.69 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Desvenlafaxine | 68.56 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Desvenlafaxine | 13.48 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: desvenlafaxine | 17.86 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Mirtazapine | 71.22 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Mirtazapine | 13.01 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: mirtazapine | 15.92 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Tianeptine | 65.33 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Tianeptine | 14.13 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: tianeptine | 13.04 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Vortioxetine | 72.53 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Vortioxetine | 10.45 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: vortioxetine | 15.56 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Monotherapy: Bupropion | 66.85 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Combination: Bupropion | 17.12 Percentage of Participants |
| Participants With Antidepressant Therapy | Percentage of Participants on Monotherapy, Combination Therapy, Augmentation Therapy During Acute Treatment Phase | Augmentation therapy: bupropion | 13.78 Percentage of Participants |