Treatment Instability in Generalized Anxiety Disorder (GAD): A U.S. Real-World Evidence Study

Abstract

Objective To characterize the treatment burden of generalized anxiety disorder (GAD) using real-world data on pharmacotherapy use, treatment changes, and treatment progression. Methods This retrospective analysis used closed claims from the Komodo Healthcare Map (2021–2024) to identify U.S. adults (≥18 years) with newly diagnosed or established GAD. Treatment patterns were assessed at the drug level. Results Among the 259,158 newly diagnosed and 1,018,288 established GAD patients, GAD-related pharmacotherapy use during the 12 months post-index was 76% and 98%, respectively. Treatment patterns were further analyzed in 59,275 newly diagnosed and 86,920 established GAD patients with ≥1 pharmacy claim. Among newly diagnosed patients, 55% discontinued and 28% added or switched treatments; among established patients, 16% discontinued and 55% added or switched treatments. The median time to first treatment event varied by cohort and event type: discontinuation occurred at a median of 84 days in newly diagnosed and 119 days in established patients, combination therapy at 49 and 32 days, and switching at 31 and 42 days, respectively. Of those who discontinued, 57% of newly diagnosed and 26% of established GAD patients did not resume treatment; among those who restarted, the median treatment gap was 146 and 96 days, respectively. Overall, 75% of newly diagnosed and 94% of established GAD patients who underwent treatment modification experienced at least one additional therapy change during the study. Conclusion This study underscores the significant unmet needs in the current treatment of GAD, evidenced by high rates of pharmacotherapy switching, discontinuation, and prolonged gaps in care.