Abstract
Objective : The role of baseline severity as effect modifier in various psychiatric disorders is a topic of controversy and of clinical import. This study aims to examine whether baseline severity modifies the efficacy of various antidepressants for major depression through individual participant data (IPD) meta-analysis. Method: We identified all placebo-controlled, double-blind randomised trials of new generation antidepressants in the acute phase treatment of major depression conducted in Japan and requested their IPD through the public–private partnerships (PPPs) between the relevant academic societies and the pharmaceutical companies. The effect modification by baseline depression severity was examined through six increasingly complex competing mixed-effects models for repeated measures. Results: We identified eleven eligible trials and obtained IPD from six, which compared duloxetine, escitalopram, mirtazapine, paroxetine or bupropion against placebo (total n = 2464). The best-fitting model revealed that the interaction between baseline severity and treatment was not statistically significant (coefficient = −0.04, 95% confidence interval: −0.16 to 0.08, P = 0.49). Several sensitivity analyses confirmed the robustness of the findings. Conclusion: We may expect as much benefit from antidepressant treatments for mild, moderate or severe major depression. Clinical practice guidelines will need to take these findings into consideration.
Original language | English |
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Pages (from-to) | 450-458 |
Number of pages | 9 |
Journal | Acta Psychiatrica Scandinavica |
Volume | 137 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2018 |
Externally published | Yes |
Bibliographical note
Funding Information:This study has been conducted within the public–private partnerships (PPPs) between the International College of Neuropsychopharmacology (CINP), the Japanese Society of Neuropsychopharmacology and pharmaceutical companies in Japan including GSK, Meiji Seika, Mochida, MSD, Pfizer and Shionogi. This study was supported in part by a grant-in-aid from Japan Agency for Medical Research and Development (AMED) to TAF (grant number JP17dk0307072) and to SY (grant number JP17 dm0107093: Strategic Research Program for Brain Sciences). GSK, Meiji Seika, Mochida and Shionogi provided permission to use their data. These entities had no role in study design, data collection, data analysis, data interpretation or writing of the report. KM had full access to all the data in the study, and TAF had final responsibility for the decision to submit for publication.
Funding Information:
This study has been conducted within the public–private partnerships (PPPs) between the International College of Neu-ropsychopharmacology (CINP), the Japanese Society of Neuropsychopharmacology and pharmaceutical companies in Japan including GSK, Meiji Seika, Mochida, MSD, Pfizer and Shionogi. This study was supported in part by a grant-in-aid from Japan Agency for Medical Research and Development (AMED) to TAF (grant number JP17dk0307072) and to SY (grant number JP17 dm0107093: Strategic Research Program for Brain Sciences). GSK, Meiji Seika, Mochida and Shionogi provided permission to use their data. These entities had no role in study design, data collection, data analysis, data interpretation or writing of the report. KM had full access to all the data in the study, and TAF had final responsibility for the decision to submit for publication.
Funding Information:
TAF has received lecture fees from Janssen, Meiji, Mitsubishi-Tanabe, MSD and Pfizer and research support from
Publisher Copyright:
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Keywords
- antidepressives
- depression
- meta-analysis