The clinical effectiveness of using a predictive algorithm to guide antidepressant treatment in primary care (PReDicT): an open-label, randomised controlled trial.

Autor: Browning M; P1vital Ltd, Howbery Park, Wallingford, UK. mbrowning@p1vital.com.; Department of Psychiatry, University of Oxford, Oxford, UK. mbrowning@p1vital.com.; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK. mbrowning@p1vital.com., Bilderbeck AC; P1vital Ltd, Howbery Park, Wallingford, UK., Dias R; P1vital Products Ltd, Howbery Park, Wallingford, UK., Dourish CT; P1vital Ltd, Howbery Park, Wallingford, UK.; P1vital Products Ltd, Howbery Park, Wallingford, UK., Kingslake J; P1vital Products Ltd, Howbery Park, Wallingford, UK., Deckert J; Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany., Goodwin GM; Department of Psychiatry, University of Oxford, Oxford, UK., Gorwood P; Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France.; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France., Guo B; Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK., Harmer CJ; Department of Psychiatry, University of Oxford, Oxford, UK., Morriss R; Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK., Reif A; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany., Ruhe HG; Department of Psychiatry, Radboudumc, Nijmegen, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands., van Schaik A; Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands., Simon J; Department of Psychiatry, University of Oxford, Oxford, UK.; Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria., Sola VP; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain. Centro de Investigación Biomédica en Red (CIBERSAM), Madrid, Spain., Veltman DJ; Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands., Elices M; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain. Centro de Investigación Biomédica en Red (CIBERSAM), Madrid, Spain., Lever AG; Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands., Menke A; Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.; Medical Park Chiemseeblick, Bernau-Felden, Germany., Scanferla E; Université Paris, ED 450, Paris, France., Stäblein M; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany., Dawson GR; P1vital Ltd, Howbery Park, Wallingford, UK.; P1vital Products Ltd, Howbery Park, Wallingford, UK.
Jazyk: angličtina
Zdroj: Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology [Neuropsychopharmacology] 2021 Jun; Vol. 46 (7), pp. 1307-1314. Date of Electronic Publication: 2021 Feb 26.
DOI: 10.1038/s41386-021-00981-z
Abstrakt: Depressed patients often do not respond to the first antidepressant prescribed, resulting in sequential trials of different medications. Personalised medicine offers a means of reducing this delay; however, the clinical effectiveness of personalised approaches to antidepressant treatment has not previously been tested. We assessed the clinical effectiveness of using a predictive algorithm, based on behavioural tests of affective cognition and subjective symptoms, to guide antidepressant treatment. We conducted a multicentre, open-label, randomised controlled trial in 913 medication-free depressed patients. Patients were randomly assigned to have their antidepressant treatment guided by a predictive algorithm or treatment as usual (TaU). The primary outcome was the response of depression symptoms, defined as a 50% or greater reduction in baseline score of the QIDS-SR-16 scale, at week 8. Additional prespecified outcomes included symptoms of anxiety at week 8, and symptoms of depression and functional outcome at weeks 8, 24 and 48. The response rate of depressive symptoms at week 8 in the PReDicT (55.9%) and TaU (51.8%) arms did not differ significantly (odds ratio: 1.18 (95% CI: 0.89-1.56), P = 0.25). However, there was a significantly greater reduction of anxiety in week 8 and a greater improvement in functional outcome at week 24 in the PReDicT arm. Use of the PReDicT test did not increase the rate of response to antidepressant treatment estimated by depressive symptoms but did improve symptoms of anxiety at week 8 and functional outcome at week 24. Our findings indicate that personalisation of antidepressant treatment may improve outcomes in depressed patients.
Databáze: MEDLINE
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