Using filled prescription sequences to rank antidepressants: A nationwide replication study

Area of Science:

• Pharmacovigilance
• Clinical Pharmacology
• Real-world evidence research

Background:

• Choosing the optimal first-line antidepressant is crucial for effective depression treatment.
• Antidepressant acceptability, combining efficacy and tolerability, aids medication selection.
• Previous studies have explored ranking antidepressants based on treatment adherence patterns.

Purpose of the Study:

• To replicate and validate a method for ranking antidepressants by clinical acceptability using real-world prescription data.
• To assess the utility of filled prescription sequences as a tool for evaluating antidepressant treatments.
• To identify the most clinically acceptable first-line antidepressant medications in a large, nationwide cohort.

Main Methods:

• Utilized a nationwide cohort of 1.2 million new antidepressant users from the French national health data system (SNDS) in 2011.
• Defined clinical acceptability by the continuation/failure ratio over six months post-initiation of first-line treatment.
• Failure included psychiatric hospitalization, death, or switching to another antidepressant, antipsychotic, or mood stabilizer; continuation was defined as at least two prescription refills.

Main Results:

• Escitalopram demonstrated the highest clinical acceptability.
• The subsequent ranking of antidepressants by acceptability was: fluoxetine, paroxetine, sertraline, citalopram, and venlafaxine.
• Adjusted Odds Ratios (aOR) for continuation ranged from 0.79 (95% CI: 0.77-0.81) for escitalopram to 0.66 (95% CI: 0.64-0.67) for venlafaxine.

Conclusions:

• Filled prescription sequences provide a robust, reproducible, and widely available method for ranking antidepressant treatments in real-world settings.
• This approach supports informed clinical decision-making for first-line antidepressant selection.
• The findings confirm the clinical acceptability ranking from a previous proof-of-concept study.