• Dr. Nazia Rashid, Associate Professor of Administrative Sciences for Keck Graduate Institute’s School of Pharmacy and Health Sciences, along with Industry Fellow Nicole Kowalczyk and Doctor of Pharmacy (PharmD) students enrolled in her Fundamentals of Medical Affairs (FMA) course, collaborated over the fall semester and winter break on a group of research projects. Abstracts from all four projects were accepted as poster presentations for the Academy of Managed Care Pharmacy (AMCP) Annual Meeting, which will be held in San Antonio, Texas from March 21 to March 24.

    These abstracts are as follows:

    1. “The real-world rates of treatment changes for patients with major depressive disorder newly initiated on antidepressants: A Targeted Literature Review”
      ● Authors: Nicole Kowalczyk, PharmD (Ascendis Fellow), Vahe Ratavousian (P3), Dana Abdalla (P3), Genevieve Kua (P3), Felicia Lee (P3), Nazia Rashid (Associate Professor)
    2. “Comparative Adverse Drug Reaction Rates of Auvelity versus Current Standard of Care Antidepressants Among Patients with Major Depressive Disorder (An Indirect Assessment of Clinical Trials Data)”
      ● Authors: Raymond Ching (P3), Syed Ahmed (P3), Adrienne Uhlyarik (P2), Nicole Kowalczyk PharmD (Ascendis Fellow), Paulina Tran (P3), Joseph De Los Reyes (P3), Nazia Rashid (Associate Professor)
    3. “Economic Impact of Patients with Major Depressive Disorder and Newly Initiated on Auvelity versus Escitalopram (A Decision Analysis)”
      ● Authors: Calib Hale(P3), Andrew Sparacino(P3), Andrea Roman(P3), Nicole Kowalczyk (Ascendis Fellow), Nazia Rashid (Associate Professor)
    4. “Understanding the Factors Associated with Medication Non-Adherence in Schizophrenia Patients in the US: A Targeted Literature Review”
      ● Authors: Raymond Ching (P3), Nazia Rashid (Associate Professor)

    The first three abstracts center around treatments for patients with Major Depressive Disorder (MDD), with the second two focusing specifically on Auvelity, a relatively new treatment on the market. The final abstract—an independent research project conducted by Rashid and Raymond Ching, PharmD ’24—focuses on medication non-adherence among schizophrenia patients.

    FMA is offered to KGI PharmD students pursuing a certificate in Medical and Clinical Affairs.

    “Because published research is such an important component of their CV, I wanted to step in and not only introduce them to that pharmacy component but also mentor and conduct research projects with them,” Rashid said.

    She divided the class into small groups, each focusing on a different aspect of antidepressants (ADs): treatment changes, adverse reactions, and economic impact.

    The first study is unique in that it examined real-world treatment changes instead of looking at these changes within the context of a controlled, clinical trial setting. Adherence to ADs in patients with MDD affects the response to therapy, cost of illness, and risk of relapse.

    Some patients with newly prescribed ADs switch to other treatments, while others may discontinue treatment altogether. The analysis drew upon retrospective, observational, case-control, surveys, and systematic review/meta-analyses studies.

    Overall, the range of discontinuation ranged from 30% to 69%. Patients stop treatment for various reasons, but primarily because it often takes around six weeks to begin experiencing the benefits of ADs (such as improved mood), and they may decide that the benefits are not worth it compared to the unpleasant side effects.

    Further contributing to the issue is that patients do not always tell their physicians when they discontinue or switch their treatment plan.

    These findings highlight the need for a fast-acting treatment for MDD—which is where Auvelity comes in. With Auvelity, a therapy with a novel mechanism of action, patients generally experience improvements in mood and reduction in depressive symptoms more rapidly than with selective serotonin reuptake inhibitors (SSRIs)—sometimes as early as a week.

    The second abstract examined patients’ adverse reactions on Auvelity compared to the current standard of care—citalopram, escitalopram, fluoxetine, and sertraline (all SSRIs)—using clinical trial data. Overall, it was found that patients experienced fewer adverse reactions with Auvelity and the lowest rates of nausea, constipation, diarrhea, and headache compared to the other treatments.

    The third study analyzed the economic impact of patients with MDD newly initiated on Auvelity versus escitalopram. Although Auvelity is clinically efficacious and cost-effective when viewed through remission and relapse rates, it has a much higher out-of-pocket cost.

    In fact, the cost increases by $7,191.99 (compared to escitalopram) when adding in the pharmacy cost.

    The final study examined medication non-adherence among patients with schizophrenia. Rashid and Ching performed a targeted literature review of 15 studies and found that rates of non-adherence ranged between 41% to 76% within the first year of antipsychotic (AP) therapy.

    Non-adherence is largely driven by unpleasant side effects of Aps, including weight gain, lethargy, and sexual dysfunction. Poor adherence was associated with a higher risk of relapse, rehospitalization, and higher hospitalization costs. This study highlights the need for new therapies with less adverse side effects.

    Ching appreciated gaining hands-on experience in performing literature reviews, learning literature screening methods such as PRISMA, and interpreting statistics on an in-depth level.

    “For the pharmacy profession—especially if you end up working in industry—these are very beneficial skills to have,” Ching said.

    Similarly, Adrienne Uhlyarik, PharmD ’25, felt that the skills gained from this research project have real-world applications.

    “In most of our classes, we learn about the drugs and how they work, but we don’t really learn about what happens if a patient has massive side effects or if they stop taking their medications—and the cost not just for the patient but also the economy as a whole,” Uhlyarik said.

    Rashid is proud of the students for all their hard work—particularly over winter break, as they worked non-stop for three weeks to submit the abstracts by early January.

    “The AMCP meeting in San Antonio is a great opportunity for them to meet people, learn about managed care, and land fellowships,” Rashid said.

    Ching appreciates that Rashid took the time out of her very busy schedule to facilitate these projects.

    “This was originally supposed to be a didactic course with guest speakers, but she modified it to focus on the research because she wanted to give us that experience,” Ching said. “The fact that she went out of her way when she already had so much going on shows how much she cares.”

    Syed Ahmed, PharmD ’24, shares his sentiments.

    “I would like to thank Dr. Rashid for the research opportunity and to learn about Lybalvi and Auvelity and their economic impact on patients diagnosed with schizophrenia and MDD, respectively,” Ahmed said. “I could not have done it without my colleagues Raymond and Adrienne. I’m looking forward to presenting our hard work at AMCP.”