Real-World Disability Outcomes Among Patients Treated with Cariprazine vs Other Atypical Antipsychotics as Adjunctive Treatment for Major Depressive Disorder
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Bibliographic record
Abstract
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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it