Treatment patterns for patients with treatment resistant depression in France using nationwide claims database

Abstract

AbstractBackgroundPrevalence of TRD varied widely across studies. Several treatment strategies exist to manage patient with Treatment-Resistant Depression (TRD) but evidence from real-world data is scarce. Investigating their use in real life is important to understand national prescribing practices and to refine prevalence estimation.MethodAll adult patients (≥ 18 years) with a TRD episode for the year 2019 were identified in a sample of four French regions accounting for 27% of national individuals. After exclusion of psychotic or bipolar affective disorders, Parkinson’s disease, and dementia, a TRD episode was defined 1/ by three successive sequences of different AD, or 2/ by the dispensing of several different AD together, or 3/ by an AD with a potentiator (lithium, antiepileptic drugs, antipsychotic drugs) over the same treatment period. The prevalence rate was estimated for the year 2019 and treatment patterns were described by treatment class associations and molecules.ResultsFor the year 2019, 66,810 patients were identified with a TRD episode, accounting for 23.9% of all patients treated for depression. The mean age was 56 years (±15.9) with 63.7% of women. Standardized prevalence of TRD was estimated at 35.1 per 10 000 patients, and 25.8 per 10,000 patients when excluding patients probably treated for another primary diagnosis than depression. Association of AD and antipsychotic was the most frequently used strategy, with SSRIs and second-generation antipsychotics being most prescribed.ConclusionIn conclusion, this study provides the robust population-based estimates of the prevalence of TRD in the French population. Description of treatment patterns highlight the widespread use of second-generation antipsychotics as potentiator of AD medication complemented with anxiolytics.