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To evaluate the effectiveness of vortioxetine in major depressive disorder (MDD) when used as a first-line versus second-line treatment or later. This was a post-hoc analysis of three 3-month non-interventional, prospective studies of vortioxetine in MDD – REVIDA (Malaysia, Philippines, Singapore, Thailand), PREVIDA (Pakistan) and TREVIDA (Taiwan). Improvements in depressive symptoms (PHQ-9, CGI-S), cognitive function (PDQ-D) and work productivity (WPAI) were compared between studies, and in a pooled analysis of patients using vortioxetine as the first line versus second-line treatment or later. Safety was compared between studies. Overall, 798 patients were analyzed (PREVIDA = 425, REVIDA = 130, TREVIDA = 243). Most patients in PREVIDA (60.5%)/REVIDA (57.4%) used vortioxetine as first-line treatment versus TREVIDA (21.8%). Generally, greater improvements from baseline were observed across outcome measures in PREVIDA/REVIDA versus TREVIDA (Month 3,  p  &lt; .0001). Vortioxetine as first-line treatment was associated with greater improvements in depression severity, cognition, functioning outcomes compared to second-line or later users (PHQ-9: −16.1 [6.4] vs −10.8 [8.9]; CGI-S: −2.7 [1.1] vs −2.0 [1.4]; PDQ-D: −29.5 [17.7] vs −18.5 [21.4];  p  &lt; .0001 at Month 3) as well as greater response (PHQ-9: 88.6% vs 61.5%;  p  &lt; .0001) and remission rates (PHQ-9: 75.4% vs 47.7%;  p  &lt; .0001). No new adverse events were reported outside of the product label. In the Asian real-world setting, vortioxetine showed greater improvements in depressive and cognitive symptoms, work functioning, and response and remission rates when used as first-line versus second-line treatment or later. Vortioxetine was well-tolerated irrespective of the study population across Asia.

A comparison of real-world effectiveness of vortioxetine along the treatment algorithm for major depressive disorder