A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder.
OBJECTIVE
This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder (MDD).


METHODS
Patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram (20 mg) (n = 143) or duloxetine (60 mg) (n = 151). The primary analysis of efficacy was an analysis of covariance (ANCOVA) of change from baseline to endpoint (week 24) in MADRS total score (last observation carried forward). MAIN OUTCOME MEASURES;


RESULTS
At week 8, the mean change from baseline in total MADRS score was -19.5 for patients treated with escitalopram (n = 141) and -17.4 for patients treated with duloxetine (n = 146), a difference of 2.1 points (p < 0.05). At week 8, the proportion of responders (> or = 50% decrease in MADRS) was 69% (escitalopram) and 58% (duloxetine) (p < 0.05) and remission (MADRS < or = 12) rates were 56% (escitalopram) and 48% (duloxetine) (NS). For the primary endpoint, the mean change from baseline in total MADRS score at week 24 was -23.4 for patients treated with escitalopram and -21.7 for patients treated with duloxetine, a difference of 1.7 points (p = 0.055, one-sided). The difference in mean change from baseline in MADRS total score favoured escitalopram at weeks 1, 2, 4, 8, 12 and 16 (p < 0.05). The overall withdrawal rates were 22% (escitalopram) and 25% (duloxetine) (NS). The withdrawal rate due to adverse events was lower for escitalopram (9%) compared to duloxetine (17%) (p < 0.05) and significantly more patients treated with duloxetine reported insomnia (12.6% vs. 4.9%) and constipation (8.6% vs. 2.8%).


CONCLUSIONS
Escitalopram was superior to duloxetine in acute treatment and at least as efficacious and better tolerated in long-term treatment of MDD.
Wade
A
A
CPS Clinical Research Centre, Glasgow, United Kingdom. alan@edgehill.demon.co.uk
Gembert
K
K
Florea
I
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004361:Drug Tolerance; D000068736:Duloxetine Hydrochloride; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*
D018687:Antidepressive Agents, Second-Generation; D013876:Thiophenes; D015283:Citalopram; D000068736:Duloxetine Hydrochloride