Indirect comparisons of relative efficacy estimates of zuranolone and selective serotonin reuptake inhibitors for postpartum depression

Figures & data

Figure 1. Evidence flowchart following exclusion of non-RCTs. Abbreviations. ITC, indirect treatment comparison; non-PTs, non-pharmacologic therapies; PPD, postpartum depression; PTs, pharmacologic therapies.

Figure 2. Plots of mean HAMD-17 CFB and EPDS CFB reported in study placebo arms. (A) HAMD-17 CFB^{25,42,43,51,58}. (B) EPDS CFB^25,41,42. Abbreviations. CFB, change from baseline; HAMD-17, Hamilton Rating Scale for Depression; EPDS, Edinburgh Postnatal Depression Scale. Note. The plot makes the underlying assumption of a linear change in HAMD-17/EPDS CFB between observed timepoints.

Figure 3. Bucher comparison diagram. Note. d_AB is the estimated relative effect between A and B (e.g. log odds ratio, log hazard ratio), var(d_AB) is the variance of the indirect estimate

Figure 4. Evidence networks. (A) Studies reporting HAMD-17 CFB^{25,42,43,51,58,59}. (B) Studies reporting EPDS CFB^25,41,42,59. Abbreviations. CFB, change from baseline; HAMD-17, Hamilton Rating Scale for Depression; EPDS, Edinburgh Postnatal Depression Scale; MAIC, matching-adjusted indirect comparison; SSRI, selective serotonin reuptake inhibitor. Note. Combination refers to the combination of pharmacologic therapies and non-pharmacologic therapies.

Figure 5. Forest plots displaying the results of Bucher ITCs and NMA (including MAIC) assessing EPDS CFB for a 14-day course of zuranolone treatment vs. ongoing treatment with SSRIs or placebo. Abbreviations. CFB, change from baseline; CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; MAIC, matching-adjusted indirect comparison; MD, mean difference; NMA, network meta-analysis; SSRI, selective serotonin reuptake inhibitor. Note. A negative mean difference favors zuranolone; this indicates that patients in the other treatment groups observed a smaller change from baseline than those in the zuranolone treatment arm. The zuranolone treatment course lasted for 14 days, with off-treatment follow-up through Day 45; SSRIs could be administered through the end of the study period (Week 12 in Appleby et al.⁴², Week 18 in Sharp et al.⁴¹) Last observation occurred at Day 45 for zuranolone, Week 18 for placebo, and Weeks 12 and 18 for SSRIs (Appleby et al.⁴² and Sharp et al.⁴¹, respectively). Results for the SSRI MAIC + Bucher treatment compare the zuranolone treatment arm to Sharp et al.⁴¹; results from the Placebo treatment were determined using MAIC + NMA. The NMA considered zuranolone, SSRI, placebo, and combination treatments, as outlined in Figure 4(B).

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