Clinical Summary
Clinical Summary: Head-to-Head Comparison of Vortioxetine Versus Desvenlafaxine in Patients With Major Depressive Disorder With Partial Response to SSRI Therapy: Results of the VIVRE Study
Many patients with major depressive disorder have only a partial response to a first SSRI, leaving persistent symptoms, poor functioning, and low treatment satisfaction. This study addresses a common next-step decision in practice: whether switching to vortioxetine or to an SNRI offers better outcomes after incomplete SSRI benefit.
Design
This phase IV, multicenter, randomized, double-blind, active-controlled, parallel-group study
N
603 were randomized and received at least one dose of study medication
Population
Participants were outpatients aged 18–65 years with a primary diagnosis of MDD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] criteria, confirmed by the Mini-International Neuropsychiatric Interview36), who were experiencing partial response to SSRI monotherapy (ie, escitalopram, sertraline, paroxetine, or citalopram at the approved dose for ≥ 6 weeks) and were, in the investigator’s opinion, suitable candidates for switching to an alternative antidepressant.
Duration
for 8 weeks, followed by a 4-week safety follow-up period
Key Findings
- Vortioxetine and desvenlafaxine had comparable depressive symptom reduction at week 8, with a numeric difference in MADRS total score favoring vortioxetine of −0.47 points (95% CI, −1.61 to 0.67; P = .420).
- More vortioxetine-treated patients achieved symptomatic and functional remission defined by CGI-S score ≤ 2: 32.5% versus 24.8%; odds ratio = 1.48 (95% CI, 1.03 to 2.15); P = .034.
- In working patients, vortioxetine produced a greater improvement in FAST total score at week 8: −16.6 versus −14.1 points; difference, −2.52 (95% CI, −4.88 to −0.15); P = .037.
- Among working patients, symptomatic and functional remission occurred in 36.2% (63/174) with vortioxetine versus 25.1% (44/175) with desvenlafaxine; OR = 1.72 (95% CI, 1.08 to 2.75; P = .023).
- Treatment satisfaction improved more with vortioxetine on the Q-LES-Q satisfaction with medication domain: 27.5% versus 23.8%; P = .044. Nausea was more frequent with vortioxetine (20.0% vs 9.2%), while TEAEs leading to withdrawal were low in both groups (1.9% and 1.0%, respectively).
Clinical Bottom Line
After partial response to an SSRI in major depressive disorder, switching to vortioxetine matched desvenlafaxine on MADRS improvement but delivered higher remission rates and better functioning, including in working patients. When functional recovery is a treatment priority, vortioxetine is a strong switch option before moving to an SNRI.
Practice Implications
- For patients with persistent symptoms after at least 6 weeks of escitalopram, sertraline, paroxetine, or citalopram, consider switching across class to vortioxetine rather than defaulting to an SNRI when the goal is remission and functional recovery.
- Assess more than depressive symptom scores after a switch; monitor global severity, daily functioning, and social functioning, since vortioxetine separated from desvenlafaxine on CGI-S remission and FAST domains despite similar MADRS change.
- In employed patients with major depressive disorder, discuss functioning at work and day-to-day performance explicitly, because vortioxetine showed greater FAST total improvement in the working subgroup (−16.6 vs −14.1 points; P = .037).
- Counsel patients that nausea was more common with vortioxetine (20.0% vs 9.2%), but discontinuations due to TEAEs were uncommon in both groups (1.9% and 1.0%).
