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Survey Finds Continued Uptake of Novel Antidepressants and Antipsychotics in Unipolar Depression Market

Effective therapies for treatment-resistant depression remain key unmet need

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that, in the unipolar depression market, the expanding use of two recently approved therapies — vortioxetine (Brintellix, Lundbeck/Takeda Pharmaceutical) and levomilnacipran ER (Fetzima, Actavis/Pierre Fabre) — together with the forecasted launch of brexpiprazole (Otsuka Pharmaceutical/Lundbeck) in the U.S., Europe, and Japan, will offset a steep near-term decline in sales resulting from the loss of market exclusivity for the two key drugs prescribed for unipolar depression: duloxetine (Cymbalta, Eli Lilly; generics) and the atypical antipsychotic agent aripiprazole (Abilify, Bristol-Myers Squibb/Otsuka Pharmaceutical) during the survey’s forecast period (2013–2023).

Unipolar depression includes major depressive disorder, minor depression, and dysthymia.

The report also finds that newer antidepressant therapies will be prescribed as third- and fourth-line treatment for patients whose depressive symptoms are inadequately addressed by generic selective serotonin reuptake inhibitors (SSRIs) and/or serotonin and norepinephrine reuptake inhibitors (SNRIs), or for patients who cannot tolerate available therapies.

In the absence of more-efficacious alternatives, the use of atypical antipsychotics as adjunctive treatment in patients with a poor response to antidepressants will continue to grow; the report says. In particular, the launch of generic aripiprazole by 2023 will drive greater use of that drug in this setting.

Vortioxetine, supported by extensive clinical trial data in depression, is expected to experience modest uptake during the forecast period as a later-line alternative in treatment non-responders. Studies have shown that the drug may improve cognition — a significant advantage over other antidepressants — and offers a low risk of weight gain and sexual dysfunction. Even as a later-line option, the relatively high price of vortioxetine will drive its major-market peak-year sales to more than $2.4 billion in 2022, the report predicts.

Moreover, the survey finds that despite extensive generic availability of early-line antidepressants and increasingly restrictive reimbursement environments across the key markets, opportunity remains for novel antidepressants because a sizable proportion of the drug-treated population responds suboptimally to available monoaminergic-targeted drugs.

“Treatment-resistant depression — that is, major depressive disorder that does not respond to at least two adequate courses of antidepressant therapy — has and will continue to be the area of greatest unmet need in the treatment of depression over the next ten years,” said analyst Alana K. Simorellis, PhD. “An agent proven to be more effective than current agents in treatment-resistant patients would be welcomed by physicians and would likely be used as part of combination therapy.”

Source: Decision Resources Group; August 13, 2014.

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