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. 2023 Jul 1:332:105-114.
doi: 10.1016/j.jad.2023.03.068. Epub 2023 Mar 22.

Real-world characteristics of European patients receiving SNRIs as first-line treatment for major depressive disorder

Lucie Bartova  1 , Gernot Fugger  2 , Markus Dold  1 , Alexander Kautzky  3 , Giuseppe Fanelli  4 , Raffaella Zanardi  5 , Diego Albani  6 , Ana Weidenauer  3 , Dan Rujescu  3 , Daniel Souery  7 , Julien Mendlewicz  8 , Stuart Montgomery  9 , Joseph Zohar  10 , Chiara Fabbri  11 , Alessandro Serretti  12 , Siegfried Kasper  13
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Free article

Real-world characteristics of European patients receiving SNRIs as first-line treatment for major depressive disorder

Lucie Bartova et al. J Affect Disord. .
Free article

Abstract

Background: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the most frequently prescribed antidepressants (ADs) for major depressive disorder (MDD), with an increasing trend in the last decade. Given the relative dearth of information regarding rationales for their preferred use as first-line ADs in the broad clinical routine, the present study systematically investigated real-world characteristics of MDD patients prescribed either SNRIs or other AD substances across different countries and treatment settings.

Methods: In the present secondary analyses based on a large European, multi-site, naturalistic and cross-sectional investigation with a retrospective assessment of treatment outcome, we firstly defined the proportion of MDD patients receiving SNRIs as first-line AD psychopharmacotherapy and secondly compared their sociodemographic and clinical characteristics to those patients prescribed alternative first-line ADs during their current major depressive episode (MDE).

Results: Within the total sample of 1410 MDD patients, 336 (23.8 %) received first-line SNRIs. Compared to other ADs, SNRIs were significantly associated with inpatient care, suicidality and treatment resistance during the current MDE, and a longer lifetime duration of psychiatric hospitalizations. Moreover, greater severity of depressive symptoms at study entry, higher daily doses of the administered ADs, as well as more frequent prescriptions of psychopharmacotherapeutic add-on strategies in general and antipsychotic augmentation in particular, were significantly related to first-line SNRIs.

Conclusions: Considering the limitations of a cross-sectional and retrospective study design, our data point towards a preferred use of first-line SNRIs in a generally more severely ill MDD patients, although they did not lead to superior treatment outcomes compared to alternative ADs.

Keywords: Antidepressant treatment; Antidepressants; Major depressive disorder; Psychopharmacotherapy; Serotonin-norepinephrine reuptake inhibitors.

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Conflict of interest statement

Conflict of interest Within the last three years, Dr. Bartova has received travel grants and consultant/speaker honoraria from Alpine Market Research, Angelini, Biogen, Diagnosia, Dialectica, Janssen, Lundbeck, Market Access Transformation, Medizin Medien Austria, Novartis, Schwabe and Universimed. Dr. Fugger has received consultant/speaker honoraria from Janssen and Angelini. Dr. Dold has received travel grants and consultant/speaker honoraria from Medizin Medien Austria, Janssen and Universimed. Dr. Rujescu has received grant/research support from Janssen and Lundbeck; he has served as a consultant or on advisory boards for Janssen and Rovi and he has served on speakers bureaus of Janssen and Pharmagenetix. Dr. Souery has received grant/research support from GlaxoSmithKline and Lundbeck; and he has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Lundbeck. Dr. Mendlewicz is a member of the board of the Lundbeck International Neuroscience Foundation and of the advisory board of Servier. Dr. Zohar has received grant/research support from Lundbeck, Servier, and Pfizer; he has served as a consultant or on the advisory boards for Servier, Pfizer, Solvay, and Actelion; and he has served on speakers' bureaus for Lundbeck, GlaxoSmithKline, Jazz, and Solvay. Dr. Montgomery has served as a consultant or on advisory boards for Lundbeck. Dr. Fabbri has served as speaker for Janssen. Dr. Serretti has served as a consultant or speaker for Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier and Taliaz. Dr. Kasper has received grant/research support from Lundbeck; he has served as a consultant or on advisory boards for Angelini, Biogen, Esai, Janssen, IQVIA, Lundbeck, Mylan, Recordati, Sage and Schwabe; and he has served on speakers bureaus for Abbott, Angelini, Aspen Farmaceutica S.A., Biogen, Janssen, Lundbeck, Recordati, Sage, Sanofi, Schwabe, Servier, Sun Pharma and Vifor.

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