Meta-analysis of venlafaxine: RESULTS

Meta-analysis of venlafaxine: RESULTS

A total of 234 studies were identified in the literature search for the meta-analysis of efficacy rates. Of those studies, 187 (79.9%) were excluded for the reasons listed in Table 1. As a result, 37 RCTs yielding 56 study arms were used in the analysis of efficacy rates. Inter-rater agreement for study selection yielded a kappa of 0.81 (P<0.05), and data were extracted by full consensus (100%). flovent inhaler

TABLE 1 Log of rejected studies and reasons for rejection

Reason for rejection (number of studies rejected)Inappropriate outcome Author (reference)Aberg , Aberg-Wistedt et al , Agosti et al , Alino et al , Amore et al ,Amsterdam et al , Barrelet et al , Bougerol et al , Bramanti et al , Chouinard , Claghorn , Cohn et al , Cole and Bodkin , Conti et al , Danish University Antidepressant Group , De Maio et al , Dencker et al , Doogan and Caillard , Fabre et al , Fairweather et al , Feighner et al , Gabelic and Moll , Giedke et al , Gravem et al , Guelfi et al , Haider et al , Hormazabal et al , Judd et al , Katon et al ,Kerkhofs et al , Kerr et al , Khan et al , Kiev , Koncevoj et al , Laakmann et al , Levine et al , Liisberg et al , Logue and Sachais , Loudon et al , March et al , Mellsop et al , Mendels et al , Miller et al , Mindham , Molnar ,Montgomery et al , Moyes et al , Murphy , Mynors-Wallis et al , Nair et al , Newburn et al , Overall et al , Perez and Ashford , Perry et al , Peselow et al , Phanjoo et al , Potter et al , Preskorn , Preskorn and Fast , Quitkin et al ,Rahman et al , Roth et al , Rudolph et al , Saletu and Grunberger , Schweizer et al , Seppala et al , Shrivastava et , Siddiqui et al , Simpson et al , Tegeler et al , Tinguely et al , Tollefson et al , Tudor and Zaharia , Wernicke , Wistedt et al , Ziegler et al
Inappropriate condition Aberg-Wistedt , Andersen , Barnes and Guarino , Baumhackl , Bennie et al , Blacker et al , Bohacek et al , Borson et al , Botros et al , Capponi , Coleman and Block , Dahl et al , Delgado et al , Dick and Ferrero ,Emrich et al , Evans et al , Frank et al , Frankenburg and Hegarty ,Gastfriend et al , Golden , Guy et al , Johnson , Klok et al ,Kramer etal , Kudleretal , Lauritzen et al , Lipseyetal Lonnqvist et al , Maguire et al , Marin et al , Nierenberg et al , Nolen et al , Norton et al , Ohrberg et al , Panerai et al , Reimherr et al , Reist et al , Sachs , Schiffer and Wineman , Singh et al , Stewart et al , Sullivan et al , Vorbach et al , White et al , Zajecka et al
Inappropriate patients Altamura et al , Bloenik et al , Carney et al , Cohn et al ,deJongheetal , Dunneretal , Feighner etal , Feighner and Cohn ,Geller et al , Hazell et al , Leonard et al , Nelson et al , Reynolds et al , Stewart et al , Wakelin et al
Inappropriate drug regimen Charney et al , Cournoyer et al , Davidson et al , Fava et al , Feet et al , Feldmann et al , Guelfi et al , Klieser et al , Kupfer et al , Lingjaerde et al , Nelson et al , Ontiveros et al , Reynolds et al , Zajecka et al
Inappropriate patient setting Bowden et al , de Wilde et al , Guillibert et al , Keegan et al , Reynaert et al
Inappropriate design Stewart et al , Tignol et al
Data not extractable Cunningham et al , Feighner etal
Duplicate study Feighner and Boyer
Inaccessible paper Abuzzahab , Amin et al , Annseau et al , Cassano et al , Feighner et al , Hamilton et al , Harris et al , Hutchison et al , Kasper et al , Rosenbaum , Schweizer et al , Scott et al , Stollmaier et al , Versiani et al

Tables 2 and 3 describe the accepted trials, along with the meta-analytical results, for out-patients and in-patients, respectively. Data from 2380 out-patients in 42 arms of RCTs and from 573 in-patients in 14 trial arms are presented. For both out-patients and in-patients, venlafaxine had the highest overall success rates, followed by SSRIs. TCAs had the lowest success rate in both clinical scenarios. The difference for outpatients was significant between venlafaxine and both other drugs (P<0.001), but for in-patients, there was no difference (P=0.36 versus SSRIs and P=0.118 versus TCAs.

TABLE 2 Meta-analytical results for efficacy rates of antidepressants in out-patients

Class, drug, author (reference)Serotonin norepinephrine reuptake inhit Venlafaxine* Successiitors (n=299) (%)
Dierick et al 107/148 72.3)
Lecrubier et al 47/78 60.3)
Schweizer et al 56/73 76.7)
Selective serotonin reuptake inhibitors1 (n=1452)
Fluoxetine* (n=1164)
Altamura et al 51/97 52.6)
Altamura et al 59/97 60.8)
Altamura et al 50/103 48.5)
Altamura et al 59/91 64.8)
Altamura et al 60/92 65.2)
Bremner 16/16 100)
Cohn and Wilcox 38/53 71.7)
Dierick etal 95/159 59.7)
Fawcett et al 9/12 75.0)
Feighner 12/22 54.5)
Feighner et al 35/60 58.3)
Muijen et al 12/22 54.5)
Rickels et al 9/10 90.0)
Stark and Hardison 77/123 62.6)
Wernicke et al 38/72 52.8)
Wernicke et al 43/71 60.6)
Wernicke et al 31/64 48.4)
Fluvoxamine5 (n=33)
Dominguez et al 11/16 68.8)
Lydiard et al 9/17 52.9)
Paroxetine” (n=255)
Dunbar et al 87/167 52.1)
Feighner and Boyer 20/39 51.3)
Rickels et al 27/49 55.1)
Tricyclic antidepressants** (n=629) Amitriptyline11 (n=107)
DelZompo et al 17/30 56.7)
Dominguez et al 13/19 68.4)
Eriksson et al 29/31 93.5)
Fawcett et al 7/9 77.8)
Feighner 5/22 22.7)
Syvalahti et al 12/15 80.0)
Desipramine” (n=15)
Brunswick et al 7/15 46.7)
lmipramine§§ (n=507)
Bremner 17/19 89.5)
Cohn and Wilcox 22/52 42.3)
Feighner and Boyer 11/40 27.5)
Lecrubier et al 38/75 50.7)
Lydiard et al 12/18 66.7)
Mann et al 2/9 22.2)
Mendels and Schless 13/34 38.2)
Rickels et al 26/37 70.3)
Schweizer et al 45/73 61.6)
Stark and Hardison 85/131 64.9)

*Overall success rate 0.702, 95% Cl 0.617 to 0.788; *Overall success rate 0.616, 95% Cl 0.556 to 0.675; *Overall success rate 0.632, 95% Cl 0.562 to 0.702; sOverall success rate 0.612, 95% Cl 0.448 to 0.776; 1lOverall success rate 0.525, 95% Cl 0.464 to 0.587;“Overall success rate 0.580, 95% Cl 0.472 to 0.688;ffOverall success rate 0.662,95% Cl 0.384 to 0.940; **Overall success rate 0.467,95% Cl 0.213 to 0.734; ssOverallsuccess rate 0.554,95% Cl 0.446 to 0.663

TABLE 3 Meta-analytical results for efficacy rates of antidepressants in in-patients

Class, drug, author (reference) Success (%)
Serotonin norepinephrine reuptake inhibitors* (n=164)
Venlafaxine
Benkert et al 44/85 (51.7)
Clerc et al 24/33 (72.7)
Guelfi et al 30/46 (65.2)
Selective serotonin reuptake inhibitors1 (n=84)
Fluoxetine
Clerc et al 17/34 (50.0)
Paroxetine
Geretsegger et al 18/28 (64.3)
Fluvoxamine
Lapierre et al 14/22 (63.6)
Tricyclic antidepressants* (n=325)
Amitriptyline® (n=115)
Annseau et al 12/22 (54.5)
Annseau et al 38/45 (84.4)
Geretsegger et al 18/31 (58.1)
O’Connor and Grigor 248) 11/17 (64.7)
Imipramine11 (n=210)
Benkert et al 70/82 (85.4)
Feighner 5/18 (27.8)
Gershon et al 57/100 (57.0)
Kellams et al 2/10 (20.0)

*Overall success rate 0.623, 95% Cl 0.427 to 0.749; *Overall success rate 0.586, 95% Cl 0.482 to 0.690; *Overall success rate 0.582, 95% Cl 0.430 to 0.735; sOverall success rate 0.668, 95% Cl 0.504 to 0.831; 1lOverall success rate 0.442, 95% Cl 0.283 to 0.602

Data for dropouts were not separated by site (ie, outpatients and in-patients) but were considered the same for both sets of patients. Data from 2388 patients were available. Table 4 presents dropout rates due to ADRs from antidepressant therapy. The dropout rate for venlafaxine was significantly lower than that for SSRIs (P=0.008) and TCAs (P=0.034). Table 5 displays the dropout rates from antidepressant therapy due to perceived lack of effect by the patient. In both analyses, venlafaxine had the lowest discontinuation rates, but the difference was not significant (P=0.24 due to ADRs and P=0.33 due to lack of efficacy.

TABLE 4 Meta-analytical results for rates of dropout from antidepressant therapy due to adverse drug reactions

Class, author (reference) Success (%)
Serotonin norepinephrine reuptake inhibitors* (n=801)
Cunningham et al 13/72 (18.1)
Guelfi et al 4/46 (8.7)
Khan et al 14/67 (20.9)
Lecrubier et al 12/78 (15.4)
Mendels and Schless 25/234 (10.7)
Rudolph et al 54/231 (23.4)
Schweizer et al 12/73 (16.4)
Selective serotonin reuptake inhibitors1^ (n=786)
Byerly et al 4/32 (12.5)
Cohn and Wilcox 8/54 (14.8)
Cohn et al 2/30 (6.7)
Dunbar et al 55/240 (22.9)
Feighner et al 7/31 (22.6)
Feighneretal 13/61 (21.3)
Itil et al 9/22 (40.9)
March et al 4/18 (22.2)
Reimherr et al 28/149 (18.8)
Wagner et al 26/167 (15.6)
Tricyclic antidepressants1 (n=801)
Byerly et al 4/34 (11.8)
Cohn and Wilcox 24/54 (44.4)
Cohn et al 9/30 (30.0)
Dunbar et al 85/237 (35.9)
Feighner et al 13/35 (37.1)
Feighneretal 18/58 (31.0)
Itil et al 7/25 (28.0)
March et al 3/18 (16.7)
Reimherr et al 30/149 (20.1)
Wagner et al 25/161 (15.5)

*Overall success rate 0.159, 95% Cl 0.113 to 0.204; tOverall success rate 0.179, 95% Cl 0.136 to 0.221; *Overall success rate 0.266, 95% Cl 0.195 to 0.337

TABLE 5 Meta-analytical results for rates of dropout from antidepressant therapy due to perceived lack of effect

Class, author (reference) Success (%)
Serotonin norepinephrine reuptake inhibitors* (n=734)
Cunningham et al 3/72 (4.2)
Guelfi et al 4/46 (8.7)
Lecrubier et al 0/78
Mendels and Schless 17/234 (7.3)
Rudolph et al 14/231 (6.0)
Schweizer et al 3/73 (4.1)
Selective serotonin reuptake inhibitors1 (n=804)
Byerley et al 7/32 (21.9)
Cohn et al 0/54
Cohn et al 2/30 (6.7)
Dunbar et al 25/240 (10.4)
Feighner et al 3/31 (9.7)
Feighneretal 13/61 (21.3)
Itil et al 0/22
March et al 1/18 (5.6)
Reimherr et al 11/149 (7.4)
Wagner et al 14/167 (8.4)
Tricyclic antidepressants1 (n=801)
Byerley et al 6/34 (17.6)
Cohn et al 4/54 (7.4)
Cohn et al 2/30 (6.7)
Dunbar et al 17/237 (7.2)
Feighner et al 6/35 (17.1)
Feighneretal 8/58 (13.8)
Itil et al 1/24 (4.2)
March et al 0/18
Reimherr et al 6/149 (4.0)
Wagner 19/161 (11.8)

*Overall success rate 0.056, 95% Cl 0.018 to 0.076; fOverall success rate 0.094, 95% Cl 0.043 to 0.118; *Overall success rate 0.086, 95% Cl 0.051 to 0.105

This entry was posted in Depressive disorder and tagged Depression, Dropouts, Efficacy, Meta-analysis, Selective serotonin reuptake inhibitors, Tricyclic antidepressants.