Escitalopram vs duloxetine in acute treatment of major depressive disorder: meta-analysis and systematic review

Figures & data

Figure 1 Flow diagram of study.

Abbreviation: EU-CTR, EU Clinical Trials Register.

Table 1 Basic characteristic of RCTs of Esc vs Dul in MDD

Study	Method	Number of randomized patients	Age of subjects (years)	Study duration (weeks)	Drug/dose	Diagnostic criteria	Outcome measures	Response criteria/response rate Esc: Dul	Remission criteria/remission rate	Overall discontinuation rate Esc: Dul	Discontinuation rate due to adverse events Esc: Dul
Khan et al,^Citation10 2007	RCT	278	18–80	8	Esc/10–20 mg/d Dul/60 mg/d	DSM-IV for MDD	CGI-I, CGI-S, HAMD-17, HAMD-24, MADRS	≥50% reduction in the MADRS/50%: 39.7% ≥50% reduction in the HAMD-24/44.9%: 41.3%	MADRS ≤10/30.1%: 27.8% HAMD-17 ≤7/32.4%: 30.2%	13.1%: 30.8%	2.2%: 12.8%
Nierenberg et al,^Citation8 2007	RCT	547	≥18	8	Esc/10–20 mg/d Dul/60–120 mg/d	DSM-IV for MDD	CGI-S, HADS, HAMA, HAMD-17, MADRS, PGI-I	≥50% reduction in the HAMD-17/40.8%: 43.1%	HAMD-17 ≤7/32.2%: 37.4%	24.1%: 31.1%	5.1%: 7.3%
Wade et al,^Citation9 2007	RCT	295	18–65	8	Esc/20 mg/d Dul/60 mg/d	DSM-IV-TR for MDD	CGI-I, CGI-S, HAMD-17, MADRS, SDS, SF-36	≥50% reduction in the MADRS/68.8%: 57.5% ≥50% reduction in the HAMD-24/66.7%: 55.5%	MADRS ≤10/56.0%: 47.9% HAMD-17 ≤7/48.9%: 42.5%	21.7%: 24.5%	9.1%: 17.2%

Abbreviations: CGI-I, Clinical Global Impression–Improvement scale; CGI-S, Clinical Global Impression–Severity scale; DSM, Diagnostic and Statistical Manual of Mental Disorders; Dul, duloxetine; Esc, escitalopram; HADS, Hospital Anxiety and Depression Scale; HAMA, Hamilton Anxiety Rating scale; HAMD, Hamilton Depression Rating scale; MADRS, Montgomery–Asberg Depression Rating Scale; MDD, Major Depressive Disorder; PGI-I, Patient Global Impression: Improvement scale; RCT, randomized, double-blind, placebo-controlled study; SDS, Sheehan Disability Scale scores; SF-36, 36-Item Short-Form Health Survey; TR, Text Revision.

Figure 2 Risk of bias in RCTs of Esc vs Dul in MDD.

Abbreviations: Dul, duloxetine; Esc, escitaloprram; MDD, major depressive disorder; RCT, randomized controlled trial.

Figure 3 The forest plot of HAMD-17 mean-changed scores from baseline (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; HAMD, Hamilton Depression Rating scale; SD, standard deviation.

Figure 4 The forest plot of mean-changed scores from baseline of MADRS scores (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; df, degrees of freedom; IV, inverse variance; MADRS, Montgomery–Asberg Depression Rating Scale; SD, standard deviation.

Figure 5 The forest plot of clinical response rate of HAMD relative risk (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; df, degrees of freedom; HAMD, Hamilton Depression Rating Scale; M–H, Mantel–Haenszel.

Figure 6 The forest plot of MADRS clinical response rate of relative risk (95% CI) in escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; df, degrees of freedom; MADRS, Montgomery–Asberg Depression Rating Scale; M–H, Mantel–Haenszel.

Figure 7 The forest plot of clinical remission rate by HAMMD-17 relative risk (95% CI) for escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; df, degrees of freedom; HAMD, Hamilton Depression Rating Scale; M–H, Mantel–Haenszel.

Figure 8 The forest plot of clinical remission rate by MADRS relative risk (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CI, confidence interval; df, degrees of freedom; MADRS, Montgomery–Asberg Depression Rating Scale; M–H, Mantel–Haenszel.

Figure 9 The forest plot of mean-changed scores from comparison of CGI-S (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CGI-S, Clinical Global Impression-Severity scale; CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation.

Figure 10 The forest plot of mean-end score from baseline comparing CGI-I scores (95% CI) of escitalopram vs duloxetine in major depressive disorder.

Abbreviations: CGI-I, Clinical Global Impression–Improvement scale; CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation.

KhanABoseAAlexopoulosGSGommollCLiDGandhiCDouble-blind comparison of escitalopram and duloxetine in the acute treatment of major depressive disorderClin Drug Investig2007277481492

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NierenbergAAGreistJHMallinckrodtCHDuloxetine versus escitalopram and placebo in the treatment of patients with major depressive disorder: onset of antidepressant action, a non-inferiority studyCurr Med Res Opin200723240141617288694

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WadeAGembertKFloreaIA comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorderCurr Med Res Opin20072371605161417559755

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