title: Examining the efficacy of adjunctive aripiprazole in major depressive disorder: a pooled analysis of 2 studies.
abstract: BACKGROUND
  Patients with major depressive disorder (MDD) who fail to achieve complete remission with antidepressant therapy may benefit from augmentation therapy with an atypical antipsychotic.
  
  
  METHODS
  A pooled analysis was performed on 2 identical 14-week studies (8-week prospective antidepressant therapy treatment phase followed by 6-week randomized double-blind phase) evaluating the efficacy of adjunctive aripiprazole (2-20 mg/day) in DSM-IV-TR-defined MDD patients with an inadequate response to antidepressant therapy. Primary efficacy endpoint was the mean change in Montgomery-Asberg Depression Rating Scale (MADRS) total score from end of the prospective phase (week 8) to end of randomized phase (week 14, last observation carried forward). Subgroup analyses were performed. The key secondary endpoint was mean change in Sheehan Disability Scale (SDS) mean score.
  
  
  RESULTS
  At endpoint, mean change in MADRS total score was significantly greater with adjunctive aripiprazole (-8.7) than with adjunctive placebo (-5.7; p < .001). Except for a differential treatment-by-sex interaction, change in MADRS total scores were consistently greater with adjunctive aripiprazole than with adjunctive placebo, regardless of race, age, episode duration, prior antidepressant therapy response, number of historical treatment failures, severity of depressive symptoms, and antidepressant. At endpoint, MADRS remission rates were significantly greater with adjunctive aripiprazole than with placebo (25.7% vs. 15.4%; p < .001). Adjunctive aripiprazole also demonstrated significantly greater improvements in mean change from baseline in SDS total score than adjunctive placebo (-1.2 vs. -0.6; p = .001).
  
  
  CONCLUSIONS
  Augmentation of antidepressant therapy with the atypical antipsychotic aripiprazole resulted in significant efficacy benefits across a range of subgroups of patients with MDD. Further study of a treatment-by-sex interaction is needed.
  
  
  BACKGROUND
  www.clinicaltrials.gov Identifiers: NCT00095823 and NCT00095758.
authors.affiliation: Departments of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. thase@mail.med.upenn.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: J Craig
authors.initials: JC
authors.lastname: Nelson
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Rene
authors.initials: R
authors.lastname: Swanink
authors.forename: Quynh-Van
authors.initials: QV
authors.lastname: Tran
authors.forename: Andrei
authors.initials: A
authors.lastname: Pikalov
authors.forename: Huyuan
authors.initials: H
authors.lastname: Yang
authors.forename: Berit X
authors.initials: BX
authors.lastname: Carlson
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Marcus
authors.forename: Robert M
authors.initials: RM
authors.lastname: Berman