Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy

Clin J Pain. 2013 May;29(5):377-81. doi: 10.1097/AJP.0b013e31825e45d9.

Abstract

Background: Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP.

Objective: To examine the compliance and persistence of antidepressants versus anticonvulsants in patients with NP during the first year of therapy.

Methods: Using electronic medical and pharmacy data for the Kaiser Permanente Southern California region, the adherence patterns for patients with a NP diagnosis prescribed an antidepressant or an anticonvulsant were studied. Compliance and persistence were measured using the medication possession ratio and the Refill-Sequence model, respectively.

Results: The study included 1817 patients with NP diagnosis taking either an antidepressant or an anticonvulsant. Within the antidepressant group, 42.9% were considered compliant, compared with 43.7% in the anticonvulsant group. Subanalysis of the 2 cohorts revealed that patients on venlafaxine were the most compliant (69.4%) compared with patients taking gabapentin (44.4%) and tricyclic antidepressants (41.8%) (P<0.01). Only 21.2% of patients in the antidepressant group and 21.4% in the anticonvulsant group were considered persistent with their medication refills.

Discussion: Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.

Publication types

  • Comparative Study

MeSH terms

  • Anticonvulsants / therapeutic use*
  • Antidepressive Agents / therapeutic use*
  • California / epidemiology
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Neuralgia / drug therapy*
  • Neuralgia / epidemiology*
  • Prevalence
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anticonvulsants
  • Antidepressive Agents