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

Authors Huang J, Wang Y, Chen J, Zhang Y, Yuan Z, Yue L, Haro JM, Moneta MV, Novick D, Fang YR

Received 15 December 2017

Accepted for publication 11 May 2018

Published 26 September 2018 Volume 2018:14 Pages 2473—2484


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder

Jia Huang,1 Yun Wang,1 Jun Chen,1 Yanlei Zhang,2 Zheng Yuan,2 Li Yue,2 Josep Maria Haro,3 Maria Victoria Moneta,3 Diego Novick,4 Yiru Fang1,5,6

1Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2Medical Department, Eli Lilly and Company, Shanghai, China; 3Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan De Déu, CIBERSAM, Universitat de Barcelona, Sant Boi De Llobregat, Barcelona, Spain; 4Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 5State Key Laboratory of Neuroscience, Shanghai Institutes for Biological Sciences, CAS, Shanghai, China; 6Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China

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.

Keywords: treatment, observational study, health outcomes, functioning

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