The anxiolytic effects of vortioxetine were greater among patients with generalized anxiety disorder (GAD) who had a higher level of pretreatment functioning based on working or pursuing education compared with all study patients with GAD, according to the results of research published in CNS Spectrums.
In this post-hoc analysis of 2 clinical trials, researchers compared the efficacy of vortioxetine in patients with GAD who were working or pursuing an education with the full study population. In the first clinical trial (Clinicaltrials.gov identifier: NCT00744627), 301 participants with GAD were randomly assigned to receive vortioxetine 5 mg or placebo for 8 weeks. Efficacy was assessed with the Hamilton Anxiety Rating Scale (HAM-A), response or remission, global functioning, and quality of life scales. In the second clinical trial (Clinicaltrials.gov identifier: NCT00788034), 687 participants received vortioxetine 5 mg or 10 mg for 20 weeks. At the end of the 20-week period, responders were randomly assigned to receive either vortioxetine or placebo for at least 24 weeks. Time to relapse was measured.
In the first clinical trial, a greater reduction in the HAM-A score was reported for participants who were working compared with the total population (-4.3 vs -3.8; P =.0005 and .0001, respectively). The difference in HAM-A score between vortioxetine and placebo was greater in professionals (-4.5; P =.0130) and associate professionals (-7.6; P =.0086) compared with skilled laborers (-1.8; P =.4547).
In the second clinical trial, a greater risk for relapse was reported for working participants assigned to placebo compared with those assigned to vortioxetine (hazard ratio: 2.9; P <.001). The differences in HAM-A scores for the working population, professionals, and the total population were -3.2, -5.6, and -3.2, respectively.
Global functioning and quality of life were also higher among the working population compared with the total population with vortioxetine treatment.
In an interview with Psychiatry Advisor, Roger McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto and Chairman and Executive Director of the Brain and Cognition Discovery Foundation in Toronto, Canada, explained that “people with higher levels of pretreatment work had greater responses to vortioxetine.” Dr McIntyre concluded that, “people who are working, perhaps as a function of their higher level of overall functioning, have better results with treatment. In addition to prescribing medication for anxiety, clinicians should endeavor to improve patient functioning, which may catapult anxiolytic activity.”
Christensen MC, Loft H, Florea I, McIntyre RS. Efficacy of vortioxetine in working patients with generalized anxiety disorder [published online October 30, 2017]. CNS Spectr. doi: 10.1017/S1092852917000761