Background: Anhedonia is a core feature of major depressive disorder (MDD), yet the clinical burden in real-world settings is not well understood. This retrospective cohort study assessed depression symptoms and treatment patterns among patients with MDD with and without prominent anhedonia. Methods: Patients with MDD were selected from a real-world dataset of electronic health records from mental health specialists and linked medical and pharmacy claims (OM1, Inc. Boston MA) between January 2013 through August 2023. Patients were included if the first Patient Health Questionnaire 9-item (PHQ-9) score indicated moderate to severe depression (≥ 10) with a MDD diagnosis +/-30 days. The date of the patients’ first PHQ-9 score was used as the index date. Patients with a score ≥ 2 on PHQ-9 item 1 (anhedonia) at the index date were classified as MDD with prominent anhedonia (MDD-ANH) ( n = 4,255). The remaining patients were classified as Other-MDD ( n = 1,454). Treatment patterns were assessed using prescription records in the year following the index date. The last PHQ-9 score in the year following the index date was used to assess remission rates (PHQ-9 score < 5) or persistence of moderate to severe depression. Results: A total of 5,709 patients with MDD were assessed; 74.5% were in MDD-ANH and 25.5% were in the Other-MDD cohort (met criteria for MDD but not prominent anhedonia). The mean index PHQ-9 score was 18.2 (SD = 4.2) for MDD-ANH patients and 13.5 (SD = 2.9) for Other-MDD patients. The percentage of patients treated with antidepressants was 86.4% in the MDD-ANH group and 84.7% in the Other-MDD group. After adjusting for baseline characteristics, patients with MDD-ANH were more likely to have been treated with atypical antipsychotics (OR = 1.51, p < 0.001), more likely to have switched medication (OR = 1.24, p = 0.004), and more likely to have augmented antidepressant therapy (OR = 1.16, p = 0.021) than Other-MDD patients. Patients with MDD-ANH were less likely to have achieved remission (OR = 0.82, p = 0.003) and were more likely to have persistent depression (OR = 1.50, p < 0.001) than patients with Other-MDD. Conclusions: Overall, MDD-ANH patients had higher clinical burden reflected in more depressive symptoms, higher treatment utilization and lower rates of remission compared to Other-MDD.

Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the association between prescriber choice of rivaroxaban vs. apixaban and the study outcomes of stroke/systemic embolism (SE), major bleeding, and death in a retrospective cohort of NVAF patients in the US. Initiators of either medication were linked to their prescribers and followed until the first of the study outcome, the end of rivaroxaban/apixaban use, or 365 days after initiation. PPP for each patient was the percent of rivaroxaban initiations issued by the provider for the prior 10 NVAF patients. Cox regression models tested associations between quintiles of PPP and each outcome. A total of 61,155 patients and 1726 providers were included. The IV was a strong predictor of rivaroxaban prescription (OR = 17.9; 95% CI: 16.6, 19.3). There were statistically significant associations between increasing preference for rivaroxaban and rates of major bleeding (ptrend = 0.041) and death (ptrend = 0.031), but not stroke/SE (ptrend = 0.398). This analysis provides evidence of the relative safety of apixaban over rivaroxaban for the risk of major bleeding and death.