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Treatment Adequacy Appears More Likely With Venlafaxine Extended Release Than Fluoxetine In Depressed Patients
Pharmacotherapy
02/10/2004
By Jill Taylor
Patients with depression who are newly treated with venlafaxine extended release (XR) were significantly more likely to achieve treatment adequacy than were patients newly treated with fluoxetine, say researchers.
According to Kristina S. Yu-Isenberg, PhD, of Prescription Solutions in Costa Mesa, California, United States, and colleagues, although efficacy and tolerability differences between venlafaxine XR and fluoxetine have been previously examined, few studies have addressed outcomes in a large managed care population treated in a usual care setting.
Furthermore, antidepressant treatment adequacy using the Health Plan Employer Data and Information Set (HEDIS)-derived quality indicators of depression management is insufficiently described, specifically during the acute (84 days) or continuation (180 days) phases.
To compare treatment adequacy during the acute and continuation phases between patients treated with venlafaxine XR and fluoxetine, the investigators performed a retrospective observational analysis of pharmacy claims data obtained from a managed care organization.
The study population consisted of 11,298 patients newly prescribed venlafaxine XR (7,719 patients) or fluoxetine (3,579 patients), with 7430 patients continuing treatment during follow up. Adequate dosage was defined as ± 10% of the target dose (venlafaxine XR 75-150 mg, fluoxetine 20 mg).
Analysis revealed significant differences between venlafaxine XR and fluoxetine treatment groups in adequate dosage and continuous treatment days. Patients receiving venlafaxine XR were significantly more likely to have 84 (72.4% vs. 64.8%, P < .0001) and 180 days (47.9% vs. 43.0%, P = .0001) of continuous treatment than patients receiving fluoxetine.
Moreover, significantly more patients treated with venlafaxine XR than fluoxetine received an adequate trial of 84 days (78.7% vs. 57.3%, P < .0001) and 180 days (77.1% vs. 51.9%, P < .0001).
The investigators suggest that outside of traditional safety and efficacy measures, therapy effectiveness in a real-world environment may be important in antidepressant selection.
The study was supported by Wyeth Research.
Pharmacotherapy 2004 Jan;24:1:33-40.
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