Real-World Disability Outcomes Among Patients Treated with Cariprazine vs Other Atypical Antipsychotics as Adjunctive Treatment for Major Depressive Disorder.

Abstract

Purpose: Major depressive disorder (MDD) is a disabling condition that may require adjunctive treatment with atypical antipsychotics (AAs). However, little is known about how different adjunctive AAs impact disability outcomes. This analysis compared disability events, days, and costs among patients with MDD before and after initiating adjunctive treatment with cariprazine, brexpiprazole, or aripiprazole, which all belong to a class of AAs known as dopamine partial agonists.

Patients and methods: The Merative^TM MarketScan^® Commercial Database and the Health and Productivity Management Database (1/1/2015-12/31/2022) were used to identify adults with MDD and ≥2 dispensings of cariprazine, brexpiprazole, or aripiprazole (first dispensing=index) adjunctive to antidepressant therapy. Baseline characteristics between cohorts were balanced using inverse probability of treatment weighting. Changes (post-index minus pre-index) in all-cause and mental health (MH)-related disability claim rates, days, and costs were compared for cariprazine vs brexpiprazole and cariprazine vs aripiprazole via a difference-in-difference analysis; 95% CIs were generated using nonparametric bootstrap procedures. P-values <0.05 were considered statistically significant.

Results: In the cariprazine (n=224) vs brexpiprazole (n=643) analysis, the cariprazine cohort had significantly greater reductions in all-cause disability claims, days, and costs vs the brexpiprazole cohort (between-cohort difference: -0.23 claims [P<0.05], -25.27 days [P<0.001], -$4577.08 [P<0.01], respectively). The cariprazine cohort also had a significantly greater reduction in MH-related disability days (-12.07 [P<0.05]); reductions in MH-related disability claims and mean costs vs brexpiprazole were similar. In the cariprazine (n=174) vs aripiprazole (n=2931) analysis, a significantly greater reduction for cariprazine vs aripiprazole was observed for all-cause and MH-related disability costs (all-cause: -$3275.91 [P<0.01]; MH-related: -$2196.36 [P<0.05]); reductions in all-cause and MH-related disability claims and days were similar.

Conclusion: In this real-world analysis of patients with MDD using AAs adjunctively to antidepressants, significantly greater reductions were observed in disability claims and days for cariprazine vs brexpiprazole and in disability costs for cariprazine vs aripiprazole. These results suggest that adjunctive cariprazine may have beneficial effects on disability outcomes for patients with MDD.