Real-World Disability Outcomes Among Patients Treated with Cariprazine vs Other Atypical Antipsychotics as Adjunctive Treatment for Major Depressive Disorder
Notice bibliographique
Résumé
Purpose: Major depressive disorder (MDD) is a disabling condition that may require adjunctive treatment with atypical antipsychotics (AAs). However, little is known about how different adjunctive AAs impact disability outcomes. This analysis compared disability events, days, and costs among patients with MDD before and after initiating adjunctive treatment with cariprazine, brexpiprazole, or aripiprazole, which all belong to a class of AAs known as dopamine partial agonists. Patients and Methods: The Merative TM MarketScan ® Commercial Database and the Health and Productivity Management Database (1/1/2015-12/31/2022) were used to identify adults with MDD and ≥ 2 dispensings of cariprazine, brexpiprazole, or aripiprazole (first dispensing=index) adjunctive to antidepressant therapy. Baseline characteristics between cohorts were balanced using inverse probability of treatment weighting. Changes (post-index minus pre-index) in all-cause and mental health (MH)-related disability claim rates, days, and costs were compared for cariprazine vs brexpiprazole and cariprazine vs aripiprazole via a difference-in-difference analysis; 95% CIs were generated using nonparametric bootstrap procedures. P -values < 0.05 were considered statistically significant. Results: In the cariprazine (n=224) vs brexpiprazole (n=643) analysis, the cariprazine cohort had significantly greater reductions in all-cause disability claims, days, and costs vs the brexpiprazole cohort (between-cohort difference: − 0.23 claims [ P < 0.05], − 25.27 days [ P < 0.001], −$4577.08 [ P < 0.01], respectively). The cariprazine cohort also had a significantly greater reduction in MH-related disability days (− 12.07 [ P < 0.05]); reductions in MH-related disability claims and mean costs vs brexpiprazole were similar. In the cariprazine (n=174) vs aripiprazole (n=2931) analysis, a significantly greater reduction for cariprazine vs aripiprazole was observed for all-cause and MH-related disability costs (all-cause: −$3275.91 [ P < 0.01]; MH-related: −$2196.36 [ P < 0.05]); reductions in all-cause and MH-related disability claims and days were similar. Conclusion: In this real-world analysis of patients with MDD using AAs adjunctively to antidepressants, significantly greater reductions were observed in disability claims and days for cariprazine vs brexpiprazole and in disability costs for cariprazine vs aripiprazole. These results suggest that adjunctive cariprazine may have beneficial effects on disability outcomes for patients with MDD. Plain Language Summary: Major depressive disorder (MDD) can lead to disability. Medications such as cariprazine, brexpiprazole, and aripiprazole can be used with antidepressants to treat MDD. This study compared the changes in disability outcomes in adults with MDD based on which of these medications they took with their antidepressant. Using insurance databases, we found patients with MDD using medications with antidepressants. We then looked at how disability outcomes changed from before to after starting treatment with different medications. We looked at disability events, or health events which required filing for disability. We also looked at the number of days on disability and the cost of disability. We compared before and after changes between cariprazine vs brexpiprazole and cariprazine vs aripiprazole. Compared with patients using brexpiprazole, patients using cariprazine had greater reductions in disability events, days, and costs. Patients using cariprazine vs brexpiprazole also had a greater reduction in disability days associated with mental health reasons specifically. Disability events and costs for mental health reasons were similar. For cariprazine vs aripiprazole, changes in disability events and days were similar. Changes in disability events and days for mental health-related reasons were also similar. Patients using cariprazine had a greater reduction in overall and mental health-related disability costs than patients using aripiprazole. Our results suggest that in patients with MDD, cariprazine with antidepressants had a greater benefit on disability outcomes than aripiprazole or brexpiprazole with antidepressants. This study was limited by the type of data available and smaller numbers of patients. Keywords: cariprazine, major depressive disorder, disability, brexpiprazole, aripiprazole, adjunctive therapy
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».