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Lexapro Loses First-Line Position for the Treatment of Major Depression

Use of Atypicals In Major Depression Treatment Is Growing, According to a New Report from Decision Resources

Patient-Flow Forecasts Between Pristiq and Effexor XR Need to Take Into Account Reimbursement Hurdles

WALTHAM, Mass., May 12 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that Forest Laboratories' Lexapro is no longer the leading first-line agent of choice for the treatment of major depression. Lexapro may have lost its first-line dominance because of the increasing frequency of step therapy restrictions requiring patients to first try therapy with citalopram (Forest Laboratories' Celexa, generics) before being reimbursed for Lexapro.

The new report entitled Treatment Algorithms in Major Depression also finds that although atypical antipsychotics do not capture substantial patient share until the third-line of therapy in newly diagnosed patients, third-line patient share has grown from 11.8 percent to 17.1 percent since last year's report. This growth is likely attributed to physicians' growing comfort with these agents given the FDA approval of Bristol-Myers Squibb/Otsuka's Abilify as an adjunct therapy in 2007 and the expected upcoming FDA approval of AstraZeneca's Seroquel XR for treating this disease.

"AstraZeneca's Seroquel, Pfizer's Geodon and Eli Lilly's Zyprexa all capture more patient share in the third line in our current analysis versus the analysis in our 2008 report. Even though these agents are not FDA-approved for major depression, physicians appear to be becoming more comfortable with atypicals as a class, a trend that may reflect a spill-over effect from Abilify's approval," stated Michael Malecki, Ph.D., analyst at Decision Resources.

By pairing patient-level claims data with primary survey data, the report can be used to build patient-flow models and highlight assumptions driving these models.

"Of all patients in our claims database taking Wyeth's Pristiq for major depression, only 2.6 percent took the drug on the first line. Among patients moving to Pristiq from another drug, 13.0 percent had taken Wyeth's Effexor XR on the previous line of therapy, indicating that Pristiq is drawing business from more than just Effexor XR," said Dr. Malecki. "Surveyed physicians point to better reimbursement of and greater familiarity with Effexor XR as the top reasons they choose this drug. This suggests that efforts made by Wyeth to move patients from Effexor XR to Pristiq over the next couple of years will have to overcome these hurdles. Likewise, any forecast patient-flow between these drugs will also have to take into account Pristiq's limitations."

About Treatment Algorithm Insight Series

Decision Resources combines in-depth primary research with the most extensive claims-based longitudinal patient-level data from IMS Lifelink: Health Plans Claims database to provide exceptional insight into physicians' prescribing trends and the factors that drive therapy product choice, from diagnosis through multiple courses of treatment, for a specific disease.

About Decision Resources

Decision Resources ( is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

SOURCE Decision Resources
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