重鬱症治療

Abstract

Overview

Introduction

Major Depressive Disorder (MDD) is estimated to affect over 34 million individuals yearly across the seven major markets. Only a fraction of this patient population is treated adequately, resulting in lost productivity, unnecessary patient suffering and unfulfilled revenue potential for manufacturers.

Scope

• Analysis of a survey of 180 prescribing physicians in the seven major markets as well as in-depth interviews with Key Opinion Leaders
• Detailed treatment trees showing the prevalence, diagnosis and treatment rates of Major Depressive Disorder across the seven major markets
• Discussion of the influence of treatment guidelines on physicians
• Insight into diagnostic and therapeutic unmet needs, and recommendations to aid market penetration and maximize prescription rates

Highlights

Individuals with milder forms of MDD are unlikely to present to physicians. Across the seven major markets, only around a half of individuals are then accurately diagnosed at first presentation.

Despite safety concerns surrounding some of the newer antidepressants, the prescribing habits of physicians have changed little, suggesting that the concerns may have been over-hyped.

Cymbalta (duloxetine) is at risk of being seen as a 'me-too' SNRI. Datamonitor's primary research suggests that by focusing on the treatment of painful physical symptoms of depression, Lilly might be missing the drug's more significant advantages.

Reasons to Purchase

• Identify which healthcare professional is responsible for treating patients with differing severities of MDD, allowing for efficient product marketing
• Ascertain the preferred and most frequently prescribed drugs for first and second-line therapy, gaining key insight into the competitive landscape
• Identify unmet needs to enhance development and market penetration strategies of MDD drugs

Table of Contents

• ABOUT DATAMONITOR HEALTHCARE
  • About the CNS pharmaceutical analysis team
• CHAPTER 1 EXECUTIVE SUMMARY
  • Scope of the analysis
  • Datamonitor insight into the Major Depressive Disorder (MDD) market
  • Individuals with milder forms of Major Depressive Disorder are unlikely to present to physicians. Across the seven major markets, only around a half of individuals are then accurately diagnosed at first presentation.
  • The safety concerns surrounding antidepressants have been over-hyped and are not generally shared by physicians.
  • Cymbalta (duloxetine) is at risk of being seen as a 'me-too' SNRI. Datamonitor's primary research suggests that by focusing on the treatment of painful physical symptoms of depression, Lilly might be missing the drug's more significant advantages.
• CHAPTER 2 INTRODUCTION AND SCOPE
  • Coverage of the Stakeholder Insight survey - MDD
    • Epidemiology
    • Presentation and diagnosis
    • Treatment of Major Depressive Disorder
• CHAPTER 3 COUNTRY TREATMENT TREES
  • Country treatment trees
• CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION OF MDD
  • Major Depressive Disorder: definitions and classification
    • Diagnostic criteria of MDD
      • DSM-IV
      • ICD-10
      • Severity
      • Dysthymic disorder is a milder form of depression
  • Etiology of Major Depressive Disorder
  • Epidemiology of MDD
    • Prevalence of MDD
  • Segmentation of MDD
    • Prevalence of MDD subtypes
    • Comorbidities
      • Anxiety
      • Cancer and other serious illnesses can be accompanied by depression
      • Heart disease
      • Diabetes
      • Neurodegenerative diseases
• CHAPTER 5 PRESENTATION & REFERRAL
  • Presentation rates for milder forms of MDD are low suggesting a significant untreated patient population may exist
  • The PCP is the first contact for the majority of MDD patients
  • PCPs opt to refer the patients as MDD severity increases
  • Greater patient awareness may result in greater numbers seeking help
    • Further use of internet-based screeners could increase presentation rates.
• CHAPTER 6 DIAGNOSIS OF MDD
  • A number of diagnostic tools are available to ensure correct diagnosis on presentation
    • WHO-Five Well-being Index provides a useful screener for the suspected depression
    • The Major Depression Inventory is recommended for use in diagnosing MDD
    • Clinical trials or epidemiological studies require more advanced diagnostic tools
      • The Hamilton Rating Scale for Depression (HAM-D) is the gold standard used in clinical trials.
      • The CIDI is favored for epidemiologic studies
    • Diagnosis of MDD can be confused with bipolar disorder
  • Diagnosis rate of MDD
    • Interviewed physicians ask about the key symptoms when making a diagnosis of MDD.
    • Painful physical symptoms are often associated with depression
• CHAPTER 7 TREATMENT GUIDELINES
  • Treatment guidelines aim to improve treatment outcomes but are underused outside of the US.
    • Updates to the APA guideline cover recent issues.
    • The NICE guideline includes cost-benefit assessment.
• CHAPTER 8 TREATMENTS AVAILABLE
  • Choice of treatment modality is key to the treatment outcome
    • Treatments already tried depend on the severity of depression
    • Treatments chosen by interviewed physicians
  • Drug class overview
    • MAOIs and TCAs-effective but potentially unsafe.
    • SSRIs avoid the problems of earlier antidepressants.
      • Prozac (fluoxetine)
      • Zoloft (sertraline)
      • Celexa (citalopram)
      • Lexapro (escitalopram)
      • Luvox (fluvoxamine)
      • Paxil (paroxetine)
    • SNRIs have added a new layer of available treatment options
      • Effexor (venlafaxine)
      • Cymbalta (duloxetine)
    • Other drugs have proven effective in treating MDD
      • Wellbutrin (bupropion)
      • Remeron (mirtazapine)
      • Ixel (milnacipran)
      • Edronax (reboxetine)
      • Serzone (nefazodone)
      • St.John's Wort (Hypericum perforatum)
  • Non-pharmacological treatment overview
    • Psychotherapy
      • Cognitive behavioral therapy
    • Electroconvulsive therapy (ECT)
• CHAPTER 9 PRESCRIBING TRENDS
  • Choice of prescribed drug class
    • TCAs and SSRIs are prescribed to the majority of patients
  • Choice of prescribed drugs
    • Drug choices by US physicians
      • Key prescribing trends in the US
    • Drug choices by physicians in Japan
      • Key prescribing trends in Japan
    • Drug choices by physicians in France
      • Key prescribing trends in France
    • Drug choices by physicians in Germany
      • Key prescribing trends in Germany
    • Drug choices by physicians in Italy
      • Key prescribing trends in Italy
    • Drug choices by physicians in Spain
      • Key prescribing trends in Spain
    • Drug choices by UK physicians
      • Key prescribing trends in the UK
  • First-line to second-line progression
  • Second to third line progression
  • Reasons for switching treatment
• CHAPTER 10 FACTORS INFLUENCING PRESCRIBING TRENDS
  • Choice of therapy - drug attributes
    • Efficacy
    • Side effects
      • Sexual dysfunction
      • Weight gain
      • Sleep problems
      • GI effects
    • Safety profile
      • Risk of suicide
      • Cardiovascular (CV) risks
      • Warnings given to patients
    • Comorbid anxiety
    • Ability to treat painful physical symptoms of depression
  • Other factors
    • Branded versus generic
• CHAPTER 11 IMPROVING TREATMENT OUTCOMES
  • Optimum duration of therapy
  • Remission and relapse
    • Proportion of patients achieving remission
    • Time to achieve remission
    • Proportion of patients who relapse during remission
  • Unmet needs
• APPENDIX A
  • Bibliography
  • Websites
• APPENDIX B
  • Physician research methodology
  • Physician sample breakdown
    • US
    • Japan
    • France
    • Germany
    • Spain
    • Italy
    • UK
  • Physician questionnaire
    • Section One Epidemiology and presentation
      • Epidemiology
      • Presentation and diagnosis
    • Section Two Referral patterns
    • Section Three Treatment
      • Guidelines
      • All treatments
      • Pharmacological treatment
      • Treatment of Mild Major Depressive Disorder
      • Treatment of Moderate Major Depressive Disorder
      • Treatment of Severe Major Depressive Disorder
      • General
    • Section Four Drug profiles
• APPENDIX C
  • About Datamonitor
    • About Datamonitor Healthcare
    • About the CNS analysis team
  • Disclaimer
• List of Tables
  • Table 1: Total adult population in the seven major markets, (millions)
  • Table 2: Adult MDD population estimates using 12-month prevalence, (millions)
  • Table 3: The number of individuals suffering from each MDD severity, (millions)
  • Table 4: Antidepressants approved for anxiety disorders in the US, EU and Japan
  • Table 5: Search engine hits for "Depression".
  • Table 6: Average time taken for MDD patients to achieve remission
  • Table 7: Average time taken for MDD patients to relapse
  • Table 8: US physician sample breakdown, 2005
  • Table 9: Japan physician sample breakdown, 2005
  • Table 10: France physician sample breakdown, 2005
  • Table 11: Germany physician sample breakdown, 2005
  • Table 12: Spain physician sample breakdown, 2005
  • Table 13: Italy physician sample breakdown, 2005
  • Table 14: UK physician sample breakdown, 2005
• List of Figures
  • Figure 1: The presentation, diagnosis and treatment of MDD in the US
  • Figure 2: The presentation, diagnosis and treatment of MDD in Japan
  • Figure 3: The presentation, diagnosis and treatment of MDD in France
  • Figure 4: The presentation, diagnosis and treatment of MDD in Germany
  • Figure 5: The presentation, diagnosis and treatment of MDD in Italy
  • Figure 6: The presentation, diagnosis and treatment of MDD in Spain
  • Figure 7: The presentation, diagnosis and treatment of MDD in the UK
  • Figure 8: Interviewed physicians' estimate of MDD prevalence
  • Figure 9: Physicians' perception of the severity of patients suffering from MDD across the seven major markets
  • Figure 10: Proportion of patients with mild, moderate and severe MDD that present to a physician.
  • Figure 11: Percentage of MDD patients who consult PCPs directly across the seven major markets
  • Figure 12: Percentage of patients who consult psychiatrists directly across the seven major markets
  • Figure 13: Healthcare professional types referring to psychiatrists across the seven major markets.
  • Figure 14: Percentage of interviewed physician's patients referred to another healthcare professional.
  • Figure 15: Referral of mild MDD patients to other healthcare professionals.
  • Figure 16: Referral of moderate MDD patients to other healthcare professionals.
  • Figure 17: Referral of severe MDD patients to other healthcare professionals.
  • Figure 18: Proportion of patients with mild, moderate and severe MDD that receive an accurate diagnosis at first presentation
  • Figure 19: Symptoms asked about by physicians prior to making a diagnosis of MDD
  • Figure 20: Patients reporting painful physical symptoms associated with their depression
  • Figure 21: Patients reporting painful physical symptoms associated with their depression to interviewed PCPs and psychiatrists
  • Figure 22: Use of recognized practice guidelines according to interviewed physicians across the seven major markets
  • Figure 23: Relative use of guidelines for the treatment of MDD by interviewed physicians in the US
  • Figure 24: Treatment already tried when patients first present to psychiatrists
  • Figure 25: Treatment already tried when mild MDD patients first present to psychiatrists
  • Figure 26: Treatment already tried when moderate MDD patients first present to psychiatrists
  • Figure 27: Treatment already tried when severe MDD patients first present to psychiatrists
  • Figure 28: Types of treatment chosen for MDD patients by physicians
  • Figure 29: APA guideline - Choice of treatment modalities for MDD
  • Figure 30: Types of treatment chosen for mild MDD patients
  • Figure 31: Types of treatment chosen for moderate MDD patients
  • Figure 32: Types of treatment chosen for severe MDD patients
  • Figure 33: Drug classes prescribed to MDD patients as monotherapy
  • Figure 34: Drug classes prescribed to mild MDD patients
  • Figure 35: Drug classes prescribed to moderate MDD patients
  • Figure 36: Drug classes prescribed to severe MDD patients
  • Figure 37: Drugs chosen for MDD by physicians in the US
  • Figure 38: Drugs chosen for MDD by physicians in Japan
  • Figure 39: Drugs chosen for MDD by physicians in France
  • Figure 40: Drugs chosen for MDD by physicians in Germany
  • Figure 41: Drugs chosen for MDD by physicians in Italy
  • Figure 42: Drugs chosen for MDD by physicians in Spain
  • Figure 43: Drugs chosen for MDD by physicians in the UK
  • Figure 44: The proportion of MDD patients that progress from first to second-line therapy
  • Figure 45: Time taken before physicians decide to progress MDD patients from first to second-line therapy
  • Figure 46: The proportion of MDD patients that progress from second to third-line therapy
  • Figure 47: Time taken before physicians decide to progress MDD patients from second to third-line therapy
  • Figure 48: The reasons for switching patients from first-line treatment
  • Figure 49: Influence on physicians' choice of therapy
  • Figure 50: Overall efficacy rating according to interviewed physicians.
  • Figure 51: Physicians' rating of overall side effect profile
  • Figure 52: Influence of side effects on physicians' choice of therapy
  • Figure 53: Physicians' concern about the occurrence of sexual dysfunction
  • Figure 54: Physicians' concern about the occurrence of weight gain
  • Figure 55: Physicians' concern about the occurrence of insomnia
  • Figure 56: Physicians' concern about the occurrence of GI effects
  • Figure 57: Rating of good safety profile according to interviewed physicians
  • Figure 58: Physicians' concern about risk of suicidal ideation
  • Figure 59: The black box warning added to all antidepressants in the US
  • Figure 60: Physicians that have changed their prescribing habits as a result of reports suggesting a link between antidepressant use and increased risk of suicidality
  • Figure 61: The warnings given by physicians to patients when initiating treatment with an antidepressant
  • Figure 62: Ability to treat comorbid anxiety disorders according to interviewed physicians
  • Figure 63: Ability to treat painful physical symptoms of depression according to interviewed physicians
  • Figure 64: Lilly's Cymbalta website-www.depressionhurts.com
  • Figure 65: The proportion of prescriptions for which physicians specify use of a generic product when branded version is also available
  • Figure 66: Optimum time period for MDD patients on pharmacological therapy (weighted score)
  • Figure 67: Optimum time period for mild MDD patients on pharmacological therapy
  • Figure 68: Optimum time period for moderate MDD patients on pharmacological therapy
  • Figure 69: Optimum time period for severe MDD patients on pharmacological therapy
  • Figure 70: Patients achieving remission after one treatment cycle
  • Figure 71: Weighted scores for the average time taken for MDD patients to achieve remission
  • Figure 72: Patients who relapse during remission
  • Figure 73: Unmet needs rated by interviewed physicians as the most important