Second-Generation Antidepressants for Treating Adult Depression—An Update
Adherence and Persistence in Second-Generation Antidepressants for Adults With MDD
Adherence rates in efficacy trials range between 90 and 100 percent. Results from efficacy randomized controlled trials (RCTs) did not indicate any differences in adherence among second-generation antidepressants. The evidence, however, is limited to few comparisons for which the strength of the evidence is moderate. For the majority of possible comparisons among second-generation antidepressants, the strength of the evidence is insufficient to permit conclusions about the comparative adherence. Findings from highly controlled efficacy studies may have limited applicability to real-world practice, especially because of the overall short duration of these trials. The evidence is insufficient to permit conclusions about adherence and persistence in effectiveness studies.
Comparative Adherence and Persistence of Immediate-Release Versus Extended-Release Formulations: Three studies assessed the comparative adherence of immediate-release and extended-release formulations. Based on one open-label RCT, adherence to fluoxetine weekly was higher than to fluoxetine daily; the strength of evidence for this finding is low. The only double-blinded RCT available reported no significant differences in adherence between patients treated with paroxetine IR and those receiving paroxetine CR (93% vs. 96%) over a 25-week followup period; the strength of evidence for this finding is moderate. A retrospective cohort study, based on U.S. prescription data, showed higher refill persistence for prescriptions of bupropion XL than for those of bupropion SR; the strength of evidence for this finding is low.
- Gartlehner G, Hansen RA, Morgan LC, et al. Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review. Comparative Effectiveness Review No. 46 (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I). Rockville, MD: Agency for Healthcare Research and Quality; December 2011. AHRQ Publication No. 12-EHC012-EF. Available at www.effectivehealthcare.ahrq.gov/secondgenantidep.cfm.
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