Canadian Journal of Health Technologies

High-Dose Bupropion for Depression

CDA-AMC — 2025-02-06

What Is the Issue?

Bupropion is a drug used in the treatment of depression. Bupropion is 1 of many treatment options available for depression and is associated with several side effects as well as the potential for misuse. The risk of side effects may be increased with higher daily doses of bupropion; therefore, it is important to determine the appropriate dosing for bupropion for the treatment of depression.

What Did We Do?

To help determine the appropriate dosing of bupropion for the treatment of major depressive disorder and treatment-resistant depression in adults, we sought to identify and summarize studies of the clinical efficacy and safety of high-dose (301 mg per day to 450 mg per day) versus standard-dose (≤ 300 mg per day) bupropion. We also sought to identify and summarize recommendations on the use of high-dose bupropion for the treatment of depression in evidence-based guidelines.
We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence, published since 2014. One reviewer screened articles for inclusion, based on predefined criteria.

What Did We Find?

We did not identify any studies that evaluated the clinical efficacy and safety of high-dose versus standard-dose bupropion for the treatment of depression, which met our criteria for this review.
We did not identify any evidence-based guidelines that included recommendations on the use of high-dose bupropion in adults with depression that met our criteria for this review.

What Does it Mean?

We cannot draw conclusions on the use of high-dose bupropion for the treatment of major depressive disorder or treatment-resistant depression in adults due to the lack of identified studies or evidence-based guidelines that met our criteria for this review. Future studies that compare high-dose and standard-dose bupropion for the treatment of depression could aid decision-making around the subject area of appropriate bupropion dosing.

Zilucoplan (Zilbrysq)

CDA-AMC — 2025-02-11

Canada’s Drug Agency (CDA-AMC) recommends that Zilbrysq be reimbursed by public drug plans for the treatment of generalized myasthenia gravis (gMG) in adult patients who are anti–acetylcholine receptor (AChR) antibody positive and who continue to receive standard therapy if certain conditions are met.
Zilbrysq should only be covered to treat adult patients who have received treatment for at least 1 year with 2 or more immunosuppressant therapies; or who have a history of treatment with at least 1 immunosuppressant for 1 year or more, and chronic plasma exchange, IV immunoglobulin, or subcutaneous immunoglobulin at least every 3 months for 12 months. Eligible patients should test positive for AChR antibodies, have a Myasthenia Gravis Activities of Daily Living (MG-ADL) score (which estimates patients’ ability to perform activities of daily living; score ranges from 0 to 24, with higher scores indicating more impairment) of 6 or greater, and meet the Myasthenia Gravis Foundation of America (MGFA) classification (which categorizes clinical features by increasing severity) of II (mild weakness affecting body muscles and may also include weakness in the eye muscles) to IV (severe weakness affecting body muscles and may also include weakness in the eye muscles).
Zilbrysq should not be given during a gMG exacerbation (moment when patient experiences weakness in some or all muscles, without needing assistance to breath) or crisis (moment when respiratory muscles are too weak, limiting air flow in and out of lungs, as a result patient is unable to breathe), or within 12 months of thymectomy (surgical removal of thymus gland). Zilbrysq should only be reimbursed if prescribed by or in consultation with a neurologist with expertise in managing patients with gMG and the cost of Zilbrysq is reduced. Zilbrysq should not be used concomitantly with rituximab, efgartigimod alfa, or complement inhibitors, such as eculizumab.

Baricitinib (Olumiant)

CDA-AMC — 2025-02-07

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform nonbinding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses baricitinib (Olumiant), 2 mg and 4 mg oral tablets.
Indication: Baricitinib is indicated for the treatment of adult patients with severe alopecia areata.

Lebrikizumab (Ebglyss)

CDA-AMC — 2025-02-11

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform nonbinding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses lebrikizumab (Ebglyss) injection solution for SC injection, 250 mg/2 mL (prefilled pen or prefilled syringe with needle shield).
Indication: Lebrikizumab injection is indicated for the treatment of moderate-to-severe atopic dermatitis in adults and adolescents 12 years of age and older with a body weight of at least 40 kg, whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Lebrikizumab can be used with or without topical corticosteroids.

Abemaciclib (Verzenio)

CDA-AMC — 2025-02-07

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
The assessments inform nonbinding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
This review assesses abemaciclib (Verzenio), 50 mg, 100 mg, and 150 mg oral tablets.
Indication: In combination with endocrine therapy for the adjuvant treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-positive, early breast cancer at high risk of disease recurrence based on clinicopathological features.