(362) Real-world characteristics and treatment patterns of patients with major depressive disorder initiating dextromethorphan-bupropion extended-release tablets, cariprazine, brexpiprazole, or esketamine

Background: : Auvelity® (dextromethorphan-bupropion) is an oral N-methyl-D-aspartate (NMDA) receptor antagonist and sigma-1 agonist approved in the US in August 2022 for the treatment of major depressive disorder (MDD) in adults.

Objective: : To examine the real-world characteristics and treatment patterns of patients initiating 1 of 4 branded pharmacotherapies for MDD: dextromethorphan-bupropion, cariprazine, brexpiprazole, or esketamine.

Methods: : Adults with MDD initiating dextromethorphan-bupropion, cariprazine, brexpiprazole, or esketamine were identified in the Merative™ MarketScan® Commercial and Medicare databases (Jan 2021–Mar 2024; index date = 1st prescription date). Included patients had 6 months of continuous enrollment pre- and post-index. Patient characteristics were assessed over the 6 months pre-index; MDD-related medication use was assessed in the 6 months pre- and post-index.

Results: : The dextromethorphan-bupropion, cariprazine, brexpiprazole, and esketamine cohorts included 1,472, 11,061, 4,958, and 853 patients, respectively. Demographics were similar across cohorts (mean age 39-43 years; 64.0-73.2% female; 43.8-56.6% in the southern US). In all cohorts, most patients had 2+ prior MDD treatments (52.9-65.3%). Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs) were the most common prior MDD-related medications across cohorts (47.2-58.1%, 25.0-38.3%, and 22.0-37.0% of patients, respectively). Reductions in MDD-related medication use after dextromethorphan-bupropion initiation were significant (P < 0.05), including a decrease of 20.9% in NDRIs and 13.5% in SSRIs. Reductions were also evident but less pronounced in the other cohorts.

Conclusions: : Patients initiating dextromethorphan-bupropion had similar characteristics and prior medication use to those initiating cariprazine, brexpiprazole, or esketamine. Reductions in MDD-related medication use after initiation of a treatment were most notable for patients treated with dextromethorphan-bupropion.

Sponsorship:: Axsome Therapeutics, Inc.