Comparative Safety of Pharmacologic Treatments for Persistent Depressive Disorder: A Systematic Review and Network Meta-Analysis

Autor: Hannes Mohr, Martin Härter, Alessa von Wolff, Levente Kriston, Yvonne Nestoriuc, Ramona Meister, Lars P. Hölzel
Jazyk: angličtina
Rok vydání: 2016
Předmět:
medicine.medical_treatment
Serotonin antagonist and reuptake inhibitor
lcsh:Medicine
Biochemistry
law.invention
Mathematical and Statistical Techniques
0302 clinical medicine
Randomized controlled trial
law
Medicine and Health Sciences
Antipsychotics
030212 general & internal medicine
lcsh:Science
Multidisciplinary
Depression
Pharmaceutics
Drugs
Neurochemistry
Antidepressants
Neurotransmitters
Antidepressive Agents
Research Design
Anesthesia
Physical Sciences
Statistics (Mathematics)
Research Article
medicine.drug
Biogenic Amines
Serotonin
medicine.medical_specialty
Clinical Research Design
Research and Analysis Methods
03 medical and health sciences
Drug Therapy
Internal medicine
Mental Health and Psychiatry
medicine
Humans
Amisulpride
Statistical Methods
Adverse effect
Antipsychotic
Pharmacology
Mood Disorders
business.industry
lcsh:R
Biology and Life Sciences
Trazodone
Discontinuation
lcsh:Q
Adverse Events
business
Reuptake inhibitor
Mathematics
Reuptake Inhibitors
030217 neurology & neurosurgery
Meta-Analysis
Neuroscience
Zdroj: PLoS ONE, Vol 11, Iss 5, p e0153380 (2016)
PLoS ONE
ISSN: 1932-6203
Popis: We aimed to compare the safety of antidepressants for the treatment of persistent depressive disorder (PDD) with each other and with placebo. We conducted a systematic electronic search and included randomized controlled trials that investigated antidepressants for the treatment of PDD in adults. Outcomes were the incidence of experiencing any adverse event, specific adverse events and related treatment discontinuations. We analyzed the data using traditional and network meta-analyses. Thirty-four studies that comprised 4,769 patients and examined 20 individual agents in nine substance classes were included. Almost all analyzed substance classes were associated with higher discontinuation rates than placebo including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), antipsychotics, and the serotonin antagonist and reuptake inhibitor (SARI) trazodone. The odds of experiencing any adverse event were significantly higher for TCAs and serotonin noradrenaline reuptake inhibitors (SNRIs) compared to placebo. Pairwise comparisons among the substance classes revealed that more patients receiving TCAs or SNRIs experienced any adverse event and that more patients receiving TCAs or the SARI trazodone discontinued treatment. The complementary treatment with acetyl-l-carnitine showed lower rates of experiencing any adverse event and related discontinuations than all other comparators. TCAs were primarily associated with (anti-)cholinergic and sedating adverse events. SSRIs primarily showed gastrointestinal adverse events. Patients treated with the antipsychotic amisulpride were more likely to manifest weight gain and endocrine adverse events. The comparative evidence for further agents was insufficient or lacking. The identified safety differences may be used to inform the selection among the antidepressants.
Databáze: OpenAIRE
Externí odkaz: