Clinical outcomes of patients with major depressive disorder treated with either duloxetine, escitalopram, fluoxetine, paroxetine, or sertraline

Figures & data

Table 1 Baseline patient characteristics by initial treatment

Baseline patient characteristics	Duloxetine	Escitalopram	Sertraline	Fluoxetine	Paroxetine	p-value
Overall sample
Number (%)a	555 (44.5)	184 (14.8)	164 (13.2)	153 (12.3)	190 (15.2)
Female, %	51.7	54.3	65.9	64.7	53.7	0.0031**
Age, years, mean (SD)	38.2 (10.2)	38.5 (10.8)	39.1 (10.3)	36.7 (10.4)	37.3 (11.2)	0.1539
Episode of MDD in the last 2 years, %	66.1	55.4	70.7	61.4	74.2	0.0013**
Preexisting comorbidities, %	23	26.4	36	24.3	26.8	0.0228*
Painful physical symptoms, %	58.4	47.3	47	44.4	44.4	0.0005***
CGI-S score, mean (SD)	4.5 (0.7)	4.6 (0.7)	4.5 (0.6)	4.5 (0.7)	4.6 (0.7)	0.3870
QIDS-SR16 score, mean (SD)	14.2 (4.6)	14.5 (4.8)	14.2 (5)	13.9 (5.1)	14.8 (4.9)	0.6950
SDS total score, mean (SD)	17.4 (6.3)	18.2 (6.1)	17.4 (6.3)	16.4 (7.4)	18 (6.5)	0.2661
EQ-VAS, mean (SD)	43.4 (24.4)	39.1 (26.5)	43.6 (27.5)	40.8 (28.5)	47.3 (25.0)	0.0391**
EQ-5D utility score, mean (SD)	0.46 (0.32)	0.46 (0.32)	0.46 (0.34)	0.50 (0.32)	0.49 (0.35)	0.0807
Asian sample
Number (%)a	382 (55.4)	92 (13.4)	54 (7.8)	61 (8.9)	100 (14.5)
Female, %	46.9	50	53.7	52.5	38	0.2588
Age, years, mean (SD)	37.5 (9.8)	36.3 (9.4)	38.9 (9)	37.5 (10.8)	37.2 (11.3)	0.6217
Episode of MDD in the last 2 years, %	65.2	58.7	72.2	62.3	72	0.2739
Preexisting comorbidities, %	13.4	14.4	35.2	23.3	16	0.0009***
Painful physical symptoms, %	55.8	52.2	44.4	52.5	36.4	0.0115*
CGI-S score, mean (SD)	4.4 (0.6)	4.3 (0.5)	4.4 (0.5)	4.4 (0.6)	4.5 (0.7)	0.3144
QIDS-SR16 score, mean (SD)	13.4 (4.5)	13.2 (4.7)	12.1 (5.1)	13.7 (4.1)	13.7 (4.5)	0.4445
SDS total score, mean (SD)	16.2 (6.1)	16.6 (6.1)	15.6 (5.8)	15.6 (6.8)	15.9 (6.3)	0.7211
EQ-VAS, mean (SD)	44.3 (23.6)	43.4 (23.7)	49.0 (28.2)	41.2 (25.8)	51.9 (22.3)	0.0107*
EQ-5D, mean (SD)	0.53 (0.30)	0.53 (0.31)	0.56 (0.31)	0.58 (0.28)	0.60 (0.31)	0.0025**

Notes:

a These are percentages of patients in this treatment cohort compared with overall sample. Other percentages are proportion of individuals with that characteristic in the treatment cohort.

* p<0.05;

** p<0.01;

*** p<0.001. Statistical comparisons are conducted across treatment cohorts.

Abbreviations: CGI-S, Clinical Global Impression-Severity; EQ-5D, Euro-QoL 5 dimensions; EQ-VAS, EuroQoL visual analog scale; MDD, major depressive disorder; QIDS-SR₁₆, 16-item Quick Inventory of Depressive Symptomatology Self-Report; SDS, Sheehan Disability Scale.

Table 2 Outcomes at 24 weeks by medication started at baseline, overall sample

Outcome scales	Duloxetine	Escitalopram	Fluoxetine	Paroxetine	Sertraline		p-value
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
CGI-S	1.56 (0.88)	2.00 (1.17)	1.75 (0.94)	2.19 (1.05)	2.02 (1.08)		<0.0001
QIDS-SR16	1.97 (2.82)	3.68 (3.34)	3.76 (3.41)	3.90 (3.33)	3.40 (3.33)		<0.0001
SDS	2.81 (4.38)	4.29 (5.46)	3.63 (4.60)	4.54 (4.60)	4.00 (4.75)		<0.0001
EQ-VAS	75.6 (34.0)	63.8 (37.0)	65.0 (35.4)	70.8 (32.2)	73.7 (27.7)		<0.0001
EQ-5D utility score	0.95 (0.11)	0.90 (0.15)	0.88 (0.17)	0.90 (0.16)	0.90 (0.15)		<0.0001
	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
Clinical remission							0.0002
No	54 (9.7)	29 (15.8)	33 (21.6)	36 (18.9)	26 (15.9)	178 (14.3)
Yes	361 (65)	101 (54.9)	84 (54.9)	98 (51.6)	98 (59.8)	742 (59.6)
Lost to follow-up	140 (25.2)	54 (29.3)	36 (23.5)	56 (29.5)	40 (24.4)	326 (26.2)
Functional remission							<0.0001
No	104 (19)	54 (29.8)	44 (29.7)	64 (34.6)	49 (30.8)	315 (25.8)
Yes	312 (57.1)	77 (42.5)	73 (49.3)	70 (37.8)	75 (47.2)	607 (49.8)
Lost to follow-up	130 (23.8)	50 (27.6)	31 (20.9)	51 (27.6)	35 (22)	297 (24.4)
Recovery							<0.0001
No	115 (21.1)	55 (30.4)	53 (35.8)	69 (37.3)	54 (34)	346 (28.4)
Yes	300 (54.9)	74 (40.9)	63 (42.6)	65 (35.1)	70 (44)	572 (46.9)
Lost to follow-up	131 (24)	52 (28.7)	32 (21.6)	51 (27.6)	35 (22)	301 (24.7)

Note: Statistical comparisons are conducted across treatment cohorts.

Abbreviations: CGI-S, Clinical Global Impression-Severity; EQ-5D, Euro-QoL 5 dimensions; EQ-VAS, EuroQoL visual analog scale; QIDS-SR₁₆, 16-item Quick Inventory of Depressive Symptomatology Self-Report; SDS, Sheehan Disability Scale.

Table 3 Estimated adjusted effect of initial treatment on QIDS-SR₁₆, CGI-S, and SDS (MMRM model)

Outcome scales	Overall sample	Asian sample
	Coefficient (95% CI)	Coefficient (95% CI)
QIDS-SR16
Escitalopram versus duloxetine	1.58 (1.03 to 2.12)***	1.20 (0.51 to 1.90)**
Fluoxetine versus duloxetine	1.48 (0.90 to 2.06)***	1.55 (0.75 to 2.35)**
Paroxetine versus duloxetine	1.53 (1.00 to 2.07)***	0.61 (−0.06 to 1.29)
Sertraline versus duloxetine	1.19 (0.61 to 1.78)***	1.83 (0.88 to 2.78)**
CGI-S
Escitalopram versus duloxetine	0.40 (0.25 to 0.56)***	0.22 (0.03 to 0.41)*
Fluoxetine versus duloxetine	0.22 (0.05 to 0.38)*	0.26 (0.04 to 0.49)*
Paroxetine versus duloxetine	0.38 (0.23 to 0.54)***	0.23 (0.05 to 0.42)*
Sertraline versus duloxetine	0.32 (0.16 to 0.49)**	0.53 (0.26 to 0.79)**
SDS
Escitalopram versus duloxetine	1.43 (0.59 to 2.26)**	0.45 (−0.45 to 1.36)
Fluoxetine versus duloxetine	1.46 (0.58 to 2.34)*	1.47 (0.36 to 2.59)*
Paroxetine versus duloxetine	1.70 (0.89 to 2.52)***	0.39 (−0.51 to 1.29)
Sertraline versus duloxetine	1.37 (0.48 to 2.26)*	2.29 (1.11 to 3.47)**
EQ-VAS
Escitalopram versus duloxetine	−6.49 (−10.28 to −2.70)**	−3.62 (−8.32 to 1.07)
Fluoxetine versus duloxetine	−2.03 (−6.19 to 2.12)	−4.37 (−10.22 to 1.48)
Paroxetine versus duloxetine	−5.56 (−9.29 to −1.83)*	−2.88 (−7.52 to 1.77)
Sertraline versus duloxetine	−4.58 (−8.67 to −0.50)*	−8.53 (−14.78 to −2.28)*
EQ-5D utility score
Escitalopram versus duloxetine	−0.05 (−0.07 to −0.03)***	−0.035 (−0.063 to −0.007)*
Fluoxetine versus duloxetine	−0.07 (−0.09 to −0.04)***	−0.067 (−0.099 to −0.035)***
Paroxetine versus duloxetine	−0.04 (−0.06 to −0.02)**	−0.014 (−0.041 to 0.014)
Sertraline versus duloxetine	−0.04 (−0.06 to −0.01)*	−0.040 (−0.079 to −0.001)*

Note:

* p<0.05;

** p<0.001;

*** p<0.0001.

Abbreviations: CGI-S, Clinical Global Impression-Severity; EQ-5D, Euro-QoL 5 dimensions; EQ-VAS, EuroQoL visual analog scale; MMRM, mixed effects modeling with repeated measures; QIDS-SR₁₆, 16-item Quick Inventory of Depressive Symptomatology Self-Report; SDS, Sheehan Disability Scale.

Table 4 Estimated adjusted effect of initial treatment on clinical remission, functional remission, and recovery (GEE logistic model)a

Treatment outcome	Overall sample	Asian sample
	Odds ratio (95% CI)	Odds ratio (95% CI)
Clinical remission
Escitalopram versus duloxetine	0.46 (0.33 to 0.64)***	0.63 (0.39 to 1.02)
Fluoxetine versus duloxetine	0.42 (0.29 to 0.61)***	0.37 (0.20 to 0.70)**
Paroxetine versus duloxetine	0.40 (0.29 to 0.56)***	0.56 (0.36 to 0.89)*
Sertraline versus duloxetine	0.50 (0.35 to 0.71)**	0.34 (0.17 to 0.67)**
Functional remission
Escitalopram versus duloxetine	0.48 (0.34 to 0.67)***	0.59 (0.37 to 0.93)*
Fluoxetine versus duloxetine	0.46 (0.32 to 0.67)***	0.49 (0.25 to 0.95)*
Paroxetine versus duloxetine	0.43 (0.31 to 0.60)***	0.65 (0.39 to 1.07)
Sertraline versus duloxetine	0.49 (0.35 to 0.70)***	0.33 (0.17 to 0.62)**
Recovery
Escitalopram versus duloxetine	0.42 (0.30 to 0.60)***	0.61 (0.37 to 1)*
Fluoxetine versus duloxetine	0.38 (0.26 to 0.55)***	0.27 (0.13 to 0.56)**
Paroxetine versus duloxetine	0.45 (0.32 to 0.64)***	0.70 (0.40 to 1.21)
Sertraline versus duloxetine	0.46 (0.33 to 0.65)***	0.39 (0.18 to 0.82)*

Notes:

a GEE logistic regression model adjusted for baseline covariates.

* p<0.05;

** p<0.01;

*** p<0.001.

Abbreviation: GEE, generalized estimating equation.

Figure 1 Change in (A) QIDS-SR₁₆, (B) CGI-S, and (C) SDS over follow-up by treatment and PPS status at baseline. Notes: ^*p<0.05; ^**p<0.001; ^***p<0.0001. Statistical comparisons are conducted across treatment cohorts.

Abbreviations: CGI-S, Clinical Global Impression-Severity; PPS, painful physical symptoms; QIDS-SR₁₆, 16-item Quick Inventory of Depressive Symptomatology Self-Report; SDS, Sheehan Disability Scale.