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Abstract
Purpose
To compare treatment outcomes in patients with major depressive disorder treated with duloxetine, escitalopram, fluoxetine, paroxetine, or sertraline for up to 6 months.
Patients and methods
Data were taken from a 6-month prospective, observational study that included 1,549 major depressive disorder patients without sexual dysfunction in 12 countries. We report the overall results and those from Asian countries. Depression severity was measured using the Clinical Global Impression and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Clinical and functional remissions were defined as having a QIDS-SR16 <6, and as having a rating of <3 on all three Sheehan Disability Scale items and no reduced productivity, respectively. Mixed effects modeling with repeated measures analysis and generalized estimating equation models were used. Propensity scores were included in the models.
Results
The mixed effects modeling with repeated measures regression models showed that the Clinical Global Impression rating during follow-up was significantly lower in those patients treated with duloxetine compared with escitalopram (0.40, 95% CI 0.25 to 0.56); fluoxetine (0.22, 95% CI 0.05 to 0.38); paroxetine (0.38, 95% CI 0.23 to 0.54); and sertraline (0.32, 95% CI 0.16 to 0.49). The QIDS-SR16 of duloxetine-treated patients was significantly lower than those treated with escitalopram (1.58, 95% CI 1.03 to 2.12); fluoxetine (1.48, 95% CI 0.90 to 2.06); paroxetine (1.53, 95% CI 1.00 to 2.07); and sertraline (1.19, 95% CI 0.61 to 1.78). The probability of clinical remission of the patients treated with escitalopram, fluoxetine, paroxetine, and sertraline was lower than those treated with duloxetine (OR 0.46, 95% CI 0.33 to 0.64; OR 0.42, 95% CI 0.29 to 0.61; OR 0.40, 95% CI 0.29 to 0.56; OR 0.50, 95% CI 0.35 to 0.71; respectively). The regression analysis of functional remission also showed more favorable results for duloxetine, with OR ranging from 0.43, 95% CI 0.31 to 0.60 for paroxetine to 0.49, 95% CI 0.35 to 0.70 for sertraline. The results for the Asian countries were generally consistent.
Conclusion
Duloxetine-treated patients had better 6-month outcomes in terms of depression severity and clinical and functional remission, compared with selective serotonin reuptake inhibitor-treated patients.
Supplementary materials
The list of Ethical Review Board (ERB) for the B1J-MC-B019 observational study
AUSTRIA
Ethikkommission für das Bundesland Salzburg
CHINA
ERB of First Medical College of Haerbin University
ERB of People Hospital of Wuhan University
ERB of Second Hospital of Soochow University
ERB of Shandong Mental Health Center
ERB of Sixth University of Beijing University
ERB of Shanghai Mental Health Center
ERB of Guangzhou First People Hospital
ERB of Beijing Anding Hospital of Capital Medical University
HONG KONG
Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB)
ISRAEL
Shalvata Hospital ERB
Sheba M.C. ERB
Rambam M.C. ERB
Abarbanel Hospital ERB
Soroka M.C. ERB
MALAYSIA
Medical Ethics Committee, Universiti Malaya Medical Centre
MEXICO
Mexico Centre for Clinical Research S.A. de C.V.
PHILIPPINES
Makati Medical Institutional Review Board, Makati, Luzon
The Medical City Institutional Review Board, Ortigas Avenue, Pasig City, Metro Manila
St Luke’s Institutional Ethics Review Committee, Quezon City, Luzon
SAUDI ARABIA
Medicare Specialist Clinics, Riyadh
SINGAPORE
NHG Domain Specific Review Board
TAIWAN
Join Institutional review board, Taipei
National Taiwan University Hospital (NTUH) Research Ethics Committee (REC), Taipei
Institutional Review Board of Tri-Service General Hospital, Taipei
THAILAND
Srithanya Hospital, Nonthaburi
UNITED ARAB EMIRATES
Psychiatry Hospital Abu Dhabi, Abu Dhabi
Acknowledgments
We want to thank all the patients and investigators participating in this study.
Disclosure
Yanlei Zhang, Zheng Yuan, Li Yue, and Diego Novick are Eli Lilly and Co employees. Maria Victoria Moneta conducted the statistical analysis under a contract of CIBER with Eli Lilly and Co. Josep Maria Haro has received economic compensation for his participation in educational lectures or advisory boards of Eli Lilly and Co., Otsuka, and Lundbeck. The authors report no other conflicts of interest in this work.