What are the recommendations for using Avelity in a patient?

Auvelity (Dextromethorphan-Bupropion) for Major Depressive Disorder

Auvelity is an FDA-approved oral NMDA receptor antagonist and sigma-1 receptor agonist indicated for the treatment of major depressive disorder (MDD) in adults, approved in August 2022. 1

Clinical Use and Patient Selection

Auvelity can be initiated as monotherapy or as add-on therapy to existing antidepressants in patients with MDD. 1

Treatment Initiation Patterns

Real-world data demonstrates three distinct initiation strategies:

• Monotherapy initiation: 28.8% of patients start Auvelity without concurrent antidepressants 1
• Add-on therapy: 71.2% of patients add Auvelity to existing treatment, most commonly to SSRIs (10.7%) or SNRIs (6.5%) 1
• Treatment-naïve patients: 10.1% of patients initiate Auvelity without prior antidepressant treatment in the preceding 12 months 1

Patient Population Characteristics

Typical patients receiving Auvelity include:

• Prior treatment history: 83.7% have previously tried SSRIs (54.9%), bupropion/NDRI (40.4%), or SNRIs (35.9%) 1
• Comorbidities: 53.5% have concurrent mental health disorders, with anxiety disorders present in 47.6% 1
• Demographics: Mean age 45.1 years, 68.1% female 1

Treatment Algorithm

First-Line Consideration

Auvelity may be considered as initial monotherapy in treatment-naïve MDD patients, though real-world data shows this represents a minority of use cases 1

Second-Line or Augmentation Strategy

For patients with inadequate response to SSRIs, SNRIs, or bupropion monotherapy, Auvelity can be added to existing therapy or substituted as monotherapy. 1

The most common switching patterns involve:

• Transitioning from SSRI monotherapy (22.4% of patients) 1
• Transitioning from SNRI monotherapy (13.2% of patients) 1
• Transitioning from NDRI/bupropion monotherapy (12.8% of patients) 1

Treatment-Resistant Depression

Only 1.3% of patients in real-world data had received esketamine prior to Auvelity, suggesting Auvelity is typically used before more invasive interventions 1

Important Clinical Considerations

Comorbid Conditions

Patients with anxiety disorders represent nearly half of those treated with Auvelity, indicating its use is not contraindicated by anxiety comorbidity. 1

Geographic and Insurance Patterns

• 40.0% of patients reside in the Southern United States 1
• 58.5% have commercial insurance coverage 1

Common Pitfalls to Avoid

• Delaying treatment: Do not wait for multiple failed antidepressant trials before considering Auvelity; real-world data shows it is used relatively early in treatment sequences 1
• Assuming monotherapy requirement: Most patients (71.2%) successfully use Auvelity as add-on therapy rather than requiring complete medication switches 1
• Overlooking treatment-naïve patients: 10.1% of patients successfully initiate Auvelity without prior recent antidepressant exposure 1