Effects of desvenlafaxine on blood pressure in patients treated for major depressive disorder: a pooled analysis

Abstract

Objective:

To evaluate the effect of the serotonin-norepinephrine re-uptake inhibitor desvenlafaxine on blood pressure and incidence of new onset hypertension in pooled short-term studies and in two longer-term, randomized withdrawal studies.

Research design and methods:

Data from patients randomly assigned to desvenlafaxine 10 mg to 400 mg/day or placebo in 11 short-term (8–12 weeks), fixed-dose, double-blind, placebo-controlled studies of major depressive disorder (MDD) were pooled for analysis; two desvenlafaxine randomized withdrawal studies (36 and 46 weeks) were analyzed separately.

Clinical trial registration:

www.clinicaltrials.gov, NCT00072774, NCT00073762, NCT00277823, NCT00300378, NCT00384033, NCT00798707, NCT00863798, NCT01121484, NCT00824291, NCT01432457, NCT00075257, NCT00887224.

Main outcome measures:

Outcomes included change from baseline in supine systolic blood pressure (SSBP) and supine diastolic blood pressure (SDBP), assessed using a mixed model repeated measures (MMRM) analysis, and incidence of hypertension (defined as three consecutive second SDBP measures ≥90 mm Hg AND increase of ≥10 mm Hg from baseline and/or SSBP ≥140 mm Hg AND increase of ≥10 mm Hg), analyzed using Cochran Mantel Hanzael tests. Potential predictors of change in SSBP and SDBP at LOCF were examined by including predictor variables in a regression model.

Results:

In the pooled, short-term studies, mean changes from baseline over time in SSBP and SDBP were statistically significant compared with placebo for the desvenlafaxine doses of 10 mg/day or greater for SSBP (p ≤ 0.0004; MMRM) and 25 mg/day or greater for SDBP (p ≤ 0.0449; MMRM). The proportion of patients with new onset hypertension differed significantly from placebo for the 50, 200, and 400 mg/day doses (1.9%, 2.4%, 4.8%, respectively, vs 0.8%; all p ≤ 0.0244). Predictors of change in BP included baseline SDBP, baseline SSBP, dose, body mass index, gender, age, race, and history of hypertension.

Limitations:

Data were pooled from studies which differed somewhat in study design and patient demographics. None of the studies were originally designed to examine treatment effects on BP. Study entry criteria limit generalization of these results to medically stable patients with a primary diagnosis of MDD.

Conclusions:

Short-term desvenlafaxine treatment was associated with small but statistically significant increases in SSBP and SDBP.

Keywords: :

• Desvenlafaxine
• Blood pressure
• Hypertension
• Adverse effects
• Safety
• Serotonin-norepinephrine re-uptake inhibitor

Transparency

Declaration of funding

This study was sponsored by Pfizer.

Declaration of financial/other relationships

MET has disclosed the following: Consultant to Pfizer, but received no honorarium or financial support related to this paper. Advisory/consulting from Alkermes, AstraZeneca, Bristol-Myers Squibb, Cerecor, Eli Lilly, Dey Pharma, Forest, Gerson Lehman Group, GlaxoSmithKline (ended 2008), Guidepoint Global, Lundbeck, MedAvante, Merck, Neuronetics, Novartis (ended 2008), Otsuka, Ortho-McNeil Pharmaceuticals, Pamlab, Pfizer, Shire, Sunovian, Supernus, Takeda, Transcept. Grant support from Agency for Healthcare Research and Quality, Alkermes (ended 2/2013), Eli Lilly (ended 2012), Forest, National Institute of Mental Health, Otsuka, PharmaNeuroboost (ended 3/2013), Roche (ended 6/2013). Equity Holdings from MedAvante. Royalties from American Psychiatric Foundation, Guilford Publications, Herald House, WW Norton & Company. RJC, CGP, and KAT were employees of Pfizer during study conduct and analysis initiation. RF and JS are current employees of Pfizer. MB is an employee of Pfizer Canada Inc. CMRO Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing support was provided by Kathleen Dorries, PhD, at Peloton Advantage, LLC, and was funded by Pfizer.