Initiating dextromethorphan-bupropion extended release in patients with major depressive disorder: Delphi panel expert consensus recommendations

A panel of 10 clinicians with experience treating major depressive disorder (MDD) used a modified Delphi process to develop 27 consensus recommendations for starting the medication dextromethorphan-bupropion extended release (45 mg/105 mg). The recommendations, which achieved a mean overall agreement score of 3.8, include using the drug as a first-line treatment for MDD, including when anxiety symptoms are present; individualizing treatment based on safety information in the Prescribing Information; using it for patients who had inadequate response, residual symptoms, or intolerable side effects from prior treatments; considering drug interactions when switching or adding medications; and switching cautiously from ketamine or esketamine due to their short-to-intermediate elimination half-lives. These recommendations offer practical guidance for initiating this treatment.

Study at a glance

Abstract

OBJECTIVE: To establish consensus recommendations for initiating dextromethorphan-bupropion extended release (45 mg/105 mg) (AUVELITY) for the treatment of major depressive disorder (MDD) in adults. METHODS: = 10) with clinical experience treating MDD participated in a 3-stage modified Delphi panel procedure. An initial literature review was performed to assist in the development of draft recommendation statements. The draft recommendations were discussed and revised in two live meetings, with a series of anonymous votes taken to reach consensus for each proposed statement. Recommendations required a mean score ≥3.0 (75% agreement) to reach consensus. RESULTS: The panel reached consensus on 27 final recommendations with a mean overall agreement score of 3.8. Key consensus recommendations (abbreviated here) included: (1) dextromethorphan-bupropion is recommended as a first-line treatment for MDD, including with co-occurring symptoms of anxiety; (2) HCPs should individualize treatment decisions that prioritize safety considerations noted in the Prescribing Information; (3) dextromethorphan-bupropion is recommended for patients with inadequate response, residual symptoms, and/or intolerable side effects associated with prior MDD treatment(s); (4) when switching from (or adding to current) medication, the potential for a drug interaction should be considered, consistent with the dextromethorphan-bupropion label; and (5) switching from ketamine or esketamine should be done with caution, and with an awareness of the short-to-intermediate elimination half-lives of these drugs. CONCLUSION: These consensus panel recommendations provide real-world guidance for initiating MDD treatment with dextromethorphan-bupropion extended release and address any perceived barriers for scenarios of interest.