Real-World Disability Outcomes Among Patients Treated With Cariprazine Versus Other Atypical Antipsychotics as Adjunctive Treatment for Major Depressive Disorder
Introduction: Several atypical antipsychotics (AAs) are approved as adjunctive treatment for major depressive disorder (MDD). Given high disability burden among MDD patients, evaluation of disability outcomes among patients using AAs is needed. This real-world study compared pre-post changes in disability outcomes and costs among patients with MDD using adjunctive cariprazine, brexpiprazole, or aripiprazole.
Methods: This study utilized Merative MarketScan Commercial and Health and Productivity Management data from 01/2015-12/2022, which includes short- and long-term disability claims, days, and costs for employed, commercially-insured patients. Adults with MDD and adjunctive use of cariprazine, brexpiprazole, or aripiprazole were included. Differences in pre- and post-index rates of all-cause and mental health (MH)-related disability claims, days, and mean costs (per patient-year [PPY]) were compared using adjusted pairwise difference-in-difference models (DiD), with 95% CIs generated using non-parametric bootstrap procedures.
Results: Patients with adjunctive cariprazine (n=224) vs. brexpiprazole (n=643) had significantly greater reductions in all-cause disability claims, days, and costs (adjusted DiD PPY estimates, -0.24 [p=0.036], -25.93 [p < 0.001], -$4,823 [p=0.016], respectively) and MH-related disability days (-12.56 [p=0.036]). Reductions in other MH-related disability outcomes were numerically greater with cariprazine vs. brexpiprazole (p>0.05). Patients using adjunctive cariprazine (n=174) vs. aripiprazole (n=2,931) had significantly greater reductions in all-cause disability costs PPY (-$3,510.03 [p=0.016]). Reductions in other disability outcomes were numerically greater with cariprazine vs. aripiprazole (p>0.05).
Conclusions: Adjunctive cariprazine was associated with greater reductions in several disability outcomes vs. brexpiprazole and aripiprazole in real-world commercially-insured MDD patients, demonstrating the impact of adjunctive cariprazine in managing the disability burden among MDD patients.
