Comparative Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in Older Adults: A Network Meta-Analysis

被引:69
作者
Thorlund, Kristian [1 ,2 ,3 ]
Druyts, Eric [3 ,4 ]
Wu, Ping [3 ]
Balijepalli, Chakrapani [3 ]
Keohane, Denis [5 ]
Mills, Edward [1 ,3 ]
机构
[1] Stanford Univ, Stanford Prevent Res Ctr, Stanford, CA 94305 USA
[2] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
[3] Redwood Outcomes, Vancouver, BC V6H 3Y4, Canada
[4] Univ British Columbia, Dept Med, Vancouver, BC, Canada
[5] Pfizer Inc, New York, NY USA
基金
加拿大健康研究院;
关键词
antidepressants; network meta-analysis; comparative efficacy; comparative safety; older adults; LATE-LIFE DEPRESSION; RANDOMIZED CONTROLLED-TRIALS; PLACEBO-CONTROLLED TRIAL; CONTROLLED-RELEASE PAROXETINE; DOUBLE-BLIND; MAJOR DEPRESSION; PRIMARY-CARE; ELDERLY-PATIENTS; RISK-FACTORS; CLINICAL-TRIALS;
D O I
10.1111/jgs.13395
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
030301 [社会学]; 100201 [内科学];
摘要
ObjectivesTo establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach. DesignSystematic review and network meta-analysis. ParticipantsIndividuals aged 60 and older. MeasurementsData on partial response (defined as at least 50% reduction in depression score from baseline) and safety (dizziness, vertigo, syncope, falls, loss of consciousness) were extracted. A Bayesian network meta-analysis was performed on the efficacy and safety outcomes, and relative risks (RRs) with 95% credible intervals (CrIs) were produced. ResultsFifteen randomized controlled trials were eligible for inclusion in the analysis. Citalopram, escitalopram, paroxetine, duloxetine, venlafaxine, fluoxetine, and sertraline were represented. Reporting on partial response and dizziness was sufficient to conduct a network meta-analysis. Reporting on other outcomes was sparse. For partial response, sertraline (RR=1.28), paroxetine (RR=1.48), and duloxetine (RR=1.62) were significantly better than placebo. The remaining interventions yielded RRs lower than 1.20. For dizziness, duloxetine (RR=3.18) and venlafaxine (RR=2.94) were statistically significantly worse than placebo. Compared with placebo, sertraline had the lowest RR for dizziness (1.14) and fluoxetine the second lowest (1.31). Citalopram, escitalopram, and paroxetine all had RRs between 1.4 and 1.7. ConclusionThere was clear evidence of the effectiveness of sertraline, paroxetine, and duloxetine. There also appears to be a hierarchy of safety associated with the different antidepressants, although there appears to be a dearth of reporting of safety outcomes.
引用
收藏
页码:1002 / 1009
页数:8
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