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Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: A population-based study

Published online by Cambridge University Press:  15 April 2020

A. Sicras-Mainar ,
P. Guijarro ,
B. Armada ,
M. Blanca-Tamayo  and
R. Navarro-Artieda
A. Sicras-Mainar*
Affiliation:
Department of Planning, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain
P. Guijarro
Affiliation:
Health Economics & Outcomes Research Manager, Pfizer, Madrid, Spain
B. Armada
Affiliation:
Medical Advisor, Pfizer, Madrid, Spain
M. Blanca-Tamayo
Affiliation:
Department of Psychiatry, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain
R. Navarro-Artieda
Affiliation:
Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
*
*Corresponding author. Planning and Organizational Development, Badalona Serveis Assistencials SA, Calle Gaietà Soler, 6-8 entlo, 08911 Badalona, Barcelona, Spain. Tel.: +34 93 507 26 84. E-mail address:asicras@bsa.cat (A. Sicras-Mainar).
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Abstract

Objective

To describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder.

Methods

We carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008–2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. Main measures: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P < 0.05.

Results

Five thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 – 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR = 4.2), neuropathy (OR = 4.2) and stroke (OR = 1.9), P < 0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P < 0.001.

Conclusions

Twenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.

Keywords

Major depressionCYP2D6Substrate-substrateSubstrate-inhibitorComorbidity
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 6 , August 2014 , pp. 331 - 337
Copyright
Copyright © Elsevier Masson SAS 2014

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