Real-World Vortioxetine Prescription for Patients With Major Depressive Disorder in Japan: A Retrospective Cohort...

Vortioxetine has been approved for the treatment of patients with major depressive disorder (MDD) in Japan since 2019; however, limited data are available on its use in clinical practice. This study aimed to identify real-world prescribing patterns for first-line antidepressant treatment of patients with MDD in Japan, and to understand how patient characteristics influence treatment selection and continuation.

This retrospective cohort study utilized data from the JMDC claims database. Patients with MDD (aged ≥ 18 years) were included if they were newly prescribed antidepressants between November 1, 2019 and May 31, 2024. The primary outcome was the distribution of antidepressants prescribed as first-line treatment. Secondary outcomes included evaluating treatment patterns and characteristics among patients receiving a single antidepressant as first-line therapy.

The analysis population included 263 773 patients, of whom 97.4% had single-drug prescriptions (vortioxetine [10.2%], selective serotonin reuptake inhibitors [48.3%], serotonin-norepinephrine reuptake inhibitors [15.2%], noradrenergic and specific serotonergic antidepressants [9.8%], and other antidepressants [13.9%]), and 2.6% had multiple-drug prescriptions. Patients were less likely to be prescribed vortioxetine if they were female (odds ratio: 0.802; 95% confidence interval: 0.781-0.824) or older than 60 years (0.544; 0.498-0.594), whereas patients with somnolence (2.248; 1.152-4.385), adjustment disorders (1.488; 1.433-1.544), and nausea and vomiting (1.253; 1.194-1.315) were more likely to be prescribed vortioxetine. In the first 3 months after initiating vortioxetine treatment, 41.3% of patients continued treatment, 44.7% discontinued, and 14.0% changed treatment. Treatment change was more common in women (1.129; 1.046-1.218), and in patients with physical symptoms, whereas mental health-related comorbidities were associated with treatment persistence.

These findings suggest that vortioxetine is more commonly prescribed to working-age men in Japan, and that patient characteristics and tolerability considerations contribute to prescribing and continuation patterns in clinical practice.