title: Once-daily duloxetine 60 mg in the treatment of major depressive disorder: multicenter, double-blind, randomized, paroxetine-controlled, non-inferiority trial in China, Korea, Taiwan and Brazil.
abstract: The aim of the present paper was to compare the efficacy and safety of duloxetine with paroxetine in the acute treatment of major depressive disorder (MDD). In a randomized, double-blind trial of 8 weeks active treatment, patients with non-psychotic MDD were randomized to duloxetine 60 mg (n = 238) or paroxetine 20 mg (n = 240) once daily. Efficacy was primarily measured on change in the 17-item Hamilton Rating Scale for Depression (HAMD(17)) using a non-inferiority test with a margin of 2.2. Secondary efficacy measures included the HAMD(17) subscales, Hamilton Rating Scale for Anxiety, Clinical Global Impressions-Severity, Patient Global Impressions-Improvement, Somatic Symptoms Inventory and Visual Analog Scales (VAS) for pain. Safety measures included treatment-emergent adverse events (TEAE), vital signs, weight, laboratory analyses and electrocardiograms. Non-inferiority of duloxetine to paroxetine was demonstrated because the upper bound of the confidence interval for mean difference in HAMD(17) change (0.71) was less than the non-inferiority margin. Secondary efficacy end-points did not differ significantly between treatments with the exception of VAS back pain, where the pooled mean was lower in the duloxetine group (17.1) compared with the paroxetine group (20.3, P = 0.048). No significant differences were observed in the number of early discontinuations and overall TEAE. However, significantly greater proportions of patients in the duloxetine group experienced nausea and palpitations. No clinically relevant changes in laboratory values, vital signs, weight or electrocardiograms were observed with either treatment. The present study verifies the utility of duloxetine as an efficacious and safe treatment for both emotional and physical symptoms of MDD in this predominantly Asian patient sample.
authors.affiliation: Eli Lilly, Taipei, Taiwan.
authors.forename: Phil
authors.initials: P
authors.lastname: Lee
authors.forename: Liang
authors.initials: L
authors.lastname: Shu
authors.forename: Xiufeng
authors.initials: X
authors.lastname: Xu
authors.forename: Chuan Yue
authors.initials: CY
authors.lastname: Wang
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Lee
authors.forename: Chia-Yih
authors.initials: CY
authors.lastname: Liu
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Hong
authors.forename: Sandra
authors.initials: S
authors.lastname: Ruschel
authors.forename: Joel
authors.initials: J
authors.lastname: Raskin
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Colman
authors.forename: Gavan A
authors.initials: GA
authors.lastname: Harrison
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001938:Brazil; D002681:China; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D000068736:Duloxetine Hydrochloride; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D010147:Pain Measurement; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D013624:Taiwan; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D013876:Thiophenes; D017374:Paroxetine; D000068736:Duloxetine Hydrochloride