title: Remission of major depressive disorder without adverse events: a comparison of escitalopram versus serotonin norepinephrine reuptake inhibitors.
abstract: OBJECTIVE
  An antidepressant's tolerability, generally captured as the frequency and severity of adverse events (AEs), is often as important as its efficacy in determining treatment success. This study used a composite outcome - remission of major depressive disorder (MDD) without AEs - to compare the benefit-risk profiles of escitalopram versus the norepinephrine reuptake inhibitors (SNRIs) duloxetine and venlafaxine extended release (XR).
  
  
  METHODS
  Pooled data from three randomized, double-blind, multicenter trials were analyzed, in which patients with MDD were treated for 8 weeks with either escitalopram (n = 462) or an SNRI (n = 467).
  
  
  BACKGROUND
  clinicaltrials.gov identifiers: NCT00108979; NCT00384436.
  
  
  METHODS
  The composite outcome was defined as remission (Montgomery-Åsberg Depression Rating Scale [MADRS] score ≤10) and concurrent absence of an AE. The proportions of remitted patients free of (1) any AEs, (2) moderate-to-severe AEs, and (3) study drug-related AEs were compared between treatment groups at each study visit and longitudinally across study visits common to all trials during the first 8 weeks of treatment.
  
  
  RESULTS
  At endpoint (week 8), escitalopram-treated patients were more likely than SNRI-treated patients to experience remission free of any AEs (28.4 vs. 21.6%; p = 0.0179) and remission free of study drug-related AEs (45.2 vs. 36.8%; p = 0.0092). Compared to SNRI-treated patients, escitalopram-treated patients had 38% greater odds of remission free of any AEs, 28% greater odds of remission free of moderate-to-severe AEs, and 34% greater odds of remission free of study drug-related AEs (all p < 0.05).
  
  
  CONCLUSIONS
  Treatment of adult MDD patients with escitalopram was significantly more likely to result in remission without concurrent AEs compared to treatment with current SNRIs. Study limitations include focus on only the initial 8 weeks of treatment and exclusion of trials for which individual patient data were not obtained.
authors: Analysis Group, Inc., Boston, MA, USA. jsignorovitch@analysisgroup.com
authors: James
authors: J
authors: Signorovitch
authors: Karthik
authors: K
authors: Ramakrishnan
authors: Rym
authors: R
authors: Ben-Hamadi
authors: Andrew P
authors: AP
authors: Yu
authors: Eric Q
authors: EQ
authors: Wu
authors: Heather
authors: H
authors: Dworak
authors: M Haim
authors: MH
authors: Erder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015283:Citalopram / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D000068736:Duloxetine Hydrochloride; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014179:Neurotransmitter Uptake Inhibitors / Q000627:therapeutic use*; D009638:Norepinephrine / Q000378:metabolism*; D012074:Remission Induction; D012701:Serotonin / Q000378:metabolism*; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D003511:Cyclohexanols; D014179:Neurotransmitter Uptake Inhibitors; D013876:Thiophenes; D015283:Citalopram; D012701:Serotonin; D000069470:Venlafaxine Hydrochloride; D000068736:Duloxetine Hydrochloride; D009638:Norepinephrine