Effectiveness and the patient experience with vortioxetine vs other standard-of-care antidepressants in major depressive disorder: Real-world insights from an observational, prospective, decentralized study using the PatientsLikeMe platform

• Qualitative usability tests show need for accessible support interfaces like PLM • Vortioxetine or other SOC AD led to similar proportions with PGI-I <2 at week 12 • Higher remission rates observed with long-term vortioxetine compared with other SOC • Greater improvement in well-being and life satisfaction seen in vortioxetine cohort • Most decentralized study participants tracked goals, remained engaged for 6 months Major depressive disorder (MDD) remains a clinical challenge, showing low remission rates with standard-of-care (SOC) antidepressants (ADs). This study evaluated real-world treatment experience with vortioxetine versus SOC ADs through the online peer community PatientsLikeMe (PLM). This observational, prospective, patient-centric, decentralized study recruited adults with MDD using the PLM platform. In this 2-part study, qualitative surveys informed study flow. The quantitative study enrolled participants who started or switched SOC AD monotherapy or vortioxetine within 180 days and had baseline Patient Health Questionnaire-9 scores ≥5. Primary endpoint was proportion with Patient Global Impression of Improvement (PGI-I) score <2 at week 12 (W12). Secondary endpoints included MDD severity, MDD symptoms, and quality of life (QOL). Qualitative survey responses refined the quantitative study design. Quantitative study enrolled 352 receiving SOC and 151 receiving vortioxetine. At W12, proportions with PGI-I scores <2 were similar (vortioxetine vs SOC: 4.5% vs 1.8%; P =0.830). Mean PGI-I scores were similar at W12 (vortioxetine vs SOC: 3.5 vs 3.6; P =0.831) and lower with vortioxetine at W24 (vortioxetine vs SOC: 3.0 vs 3.4; P <0.001). Remission rates at W24 were higher with vortioxetine (11.4%) vs SOC (2.5%; P <0.001). Feelings of anhedonia were significantly less frequent with vortioxetine ( P =0.005). Self-reported data may introduce recall bias. PLM users may have higher health literacy than the general population. Although primary endpoint was not met, long-term vortioxetine was associated with improved global impression, QOL, and life satisfaction, and a higher rate of remission, which can guide clinical decisions and empower patients.