Supplementary materials: Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA

These are peer-reviewed supplementary tables for the article 'Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA' published in the Journal of Comparative Effectiveness Research.Supplementary Table 1: MDD ICD-9/10 diagnosis codesSupplementary Table 2: Factors influencing likelihood of treatment inertia in patients with elevated PHQ-9 scoreAim: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after treatment. Treatment inertia is the continued use of the same pharmacotherapy regimen when treatment goals are not met. This study assessed the frequency of treatment inertia among adult patients with MDD treated in a real-world setting. Patients & methods: This was a retrospective, observational study of patients with MDD identified in the Decision Resources Group Real World Evidence US Data Repository from January 2014 to June 2018. Patients (≥18 years) had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following 8 weeks of stable baseline antidepressant use with/without mental-health outpatient therapy. Treatment inertia, modification and discontinuation were evaluated over a 16-week follow-up period (timeline based on the APA Practice Guidelines). The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: 2850 patients (median age, 55 years; 74% female) met the study criteria. Of these patients, 834 (29%) had study-defined treatment inertia, 1534 (54%) received treatment modification and 482 (17%) discontinued treatment. Use of mirtazapine (Odd ratio [OR]: 0.63; 95% confidence interval [CI]: 0.50–0.79), selective serotonin reuptake inhibitors (OR: 0.64; 95% CI: 0.54–0.75) or bupropion (OR: 0.71; 95% CI: 0.60–0.84) in the baseline period was associated with an increased likelihood of treatment modification versus not receiving treatment with these medications. Frequency of treatment inertia may differ among those who do not have a documented PHQ-9 score. Conclusion: Effective symptom management is critical for optimal outcomes in MDD. Results demonstrate that treatment inertia is common in MDD despite guidelines recommending treatment modification in patients not reaching remission.

本数据集为发表于《比较效果研究杂志》上的文章《美国治疗重度抑郁症患者治疗惰性的现实世界评估》的同行评审补充表格。补充表1：MDD ICD-9/10诊断代码；补充表2：影响PHQ-9评分升高患者治疗惰性发生可能性的因素。研究目的：重度抑郁症（MDD）是一种导致抑郁症状在治疗后可能持续存在的致残性疾病。治疗惰性是指在未达到治疗目标的情况下，持续使用相同的药物治疗方案。本研究旨在评估在现实世界环境中接受治疗的MDD成年患者中治疗惰性的发生率。患者与方法：本研究为对2014年1月至2018年6月期间决策资源集团现实世界证据美国数据仓库中识别出的MDD患者进行的回顾性、观察性研究。患者（≥18岁）在接受8周稳定的基线抗抑郁药使用（包括/不包括心理健康门诊治疗）后，PHQ-9评分升高（≥5分）。在16周随访期（基于美国心理学会实践指南的时间线）内，评估了治疗惰性、治疗调整和停药情况。主要结局指标为经历治疗惰性的MDD患者比例。结果：2850名患者（中位年龄，55岁；74%为女性）符合研究标准。其中，834名患者（29%）存在研究定义的治疗惰性，1534名患者（54%）接受了治疗调整，482名患者（17%）停止了治疗。在基线期间使用米氮平（优势比[OR]：0.63；95%置信区间[CI]：0.50–0.79）、选择性5-羟色胺再摄取抑制剂（OR：0.64；95% CI：0.54–0.75）或安非他酮（OR：0.71；95% CI：0.60–0.84）与治疗调整的可能性增加相关，而不接受这些药物治疗与治疗调整的可能性较低。治疗惰性的发生率可能在不同未记录PHQ-9评分的患者中存在差异。结论：有效管理症状对于MDD的最佳结局至关重要。研究结果证明，尽管指南建议对未达到完全缓解的患者进行治疗调整，但MDD中治疗惰性仍然普遍存在。