BURLINGTON, Mass., Nov. 26, 2013 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that, through analysis of U.S. longitudinal patient-level claims data, close to 50 percent of first-line drug-treated major depressive disorder (MDD) patients progressed to a second-line therapy within one year of diagnosis. Although generic agents are largely prescribed second-line, particularly from the selective serotonin reuptake inhibitor (SSRI), dopaminergic/noradrenergic or serotonin norepinephrine reuptake inhibitor (SNRI) drug classes, some branded agents continue to maintain modest patient share in later lines of therapy. In particular, Eli Lilly's Cymbalta was among the top ten products used in the second line as either monotherapy or as part of a combination. This finding aligns with practices of interviewed thought leaders, who consider Cymbalta as a second- or later-line therapy after the failure of initial SSRI treatment or in patients experiencing somatic symptoms of depression (e.g., pain, fatigue).

The report Treatment Algorithms in Major Depressive Disorder finds that among newly diagnosed patients, patient share for bupropion (GlaxoSmithKline/Valeant Pharmaceuticals' Wellbutrin/Wellbutrin SR/Wellbutrin XL, generics) exceeds that of all other individual agents in the second and third lines, consistent with its use as a popular adjunctive therapy in MDD patients failing to respond to first-line SSRI or SNRI therapy and in patients who cannot tolerate the side effects of other first-line antidepressants.

The report also finds that the atypical antipsychotic class captured more than 14 percent patient share among recently treated MDD patients. Bristol-Myers Squibb/Otsuka Pharmaceutical's Abilify retains the greatest patient share in this drug class. Abilify's U.S. approval as adjunctive treatment for MDD, its lower risk of metabolic side effects relative to other agents, relatively favorable market access and what psychiatrists perceive as a more-activating side-effect profile (as opposed to the more-sedating effects of other atypical antipsychotics) give it an advantage in the market.

"Adding an atypical antipsychotic to an antidepressant for treatment-resistant depression is becoming more common, largely to address the high level of unmet need among patients who fail to respond to early-line MDD treatment," said Decision Resources Senior Business Insights Analyst Alana Simorellis, Ph.D. "While only Abilify and Seroquel XR (AstraZeneca's quetiapine XR) are approved as adjunctive therapies for MDD, many other atypical antipsychotics are being used in treatment-resistant patients. Although these latter agents are not FDA-approved for MDD, it appears that physicians are becoming more comfortable using atypical antipsychotics for this indication as a result of the approvals of Abilify and Seroquel XR."

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