Background

Treatment resistant depression (TRD) characterizes a subgroup of 10–30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy.

Methods

This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on treatment patterns and outcomes in several European countries. Patients were started on a new treatment for depression according to routine clinical practice.

Results

Among 411 patients enrolled, after 6 months, only 16.7% achieved remission and 73.5% showed no response. At Month 12, while 19.2% achieved remission and 69.2% showed no response, 33.3% of those in remission at Month 6 were no longer in remission. Pharmacological treatments employed were heterogenous; 54 different drugs were recorded at baseline, and the top 5 treatment types according to drug classes accounted for 40.0% of patients. Even though remission rates were very low, at Month 12, 60.0% of patients had not changed treatment since enrolment.

Conclusions

The heterogeneity of treatments highlights a lack of consensus. Moreover, despite low response rates, patients often remained on treatments for substantial periods of time. These data further support existence of an unmet treatment need for TRD patients in Europe.

中文翻译：

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欧洲队列研究对难治性抑郁症患者的真实证据：治疗模式和临床结果

背景

难治性抑郁症（TRD）是重度抑郁症患者的10％至30％的亚组，并具有较高的发病率和死亡率。目前尚无针对TRD的共识疗法，这通常会导致治疗策略的广泛差异。目前尚缺乏有关欧洲TRD患者治疗模式和预后的现实研究，可能有助于阐明当前的治疗策略及其疗效。

方法

这项针对中度至重度抑郁症的TRD患者（定义为对≥2种口服抗抑郁药并以适当剂量和持续时间治疗失败）的非干预队列研究收集了一些欧洲国家的治疗模式和结果的真实数据。根据常规临床实践，患者开始接受抑郁症的新治疗。

结果

在入组的411例患者中，六个月后，只有16.7％的患者获得缓解，而73.5％的患者没有反应。在第12个月，虽然有19.2％的人获得了缓解，有69.2％的人没有反应，但在第6个月中有33.3％的缓解者不再有缓解。所采用的药理学治疗方法是异质的。基线记录了54种不同的药物，并且按药物类别划分的前5种治疗类型占患者的40.0％。即使缓解率很低，在入组后第12个月，仍有60.0％的患者未改变治疗方法。

结论

治疗方法的异质性凸显了缺乏共识。此外，尽管反应率低，但患者通常仍在相当长的一段时间内接受治疗。这些数据进一步支持了欧洲对TRD患者的未满足治疗需求的存在。