Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials

Scientific paper - Original scientific paper

• Author: Vladimir Trkulja
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Aim. To evaluate clinical relevance of differences between escitalopram and citalopram (equimolar) for major depressive disorder. ----- Methods. Review and meta-analysis of comparative randomized controlled trials (RCT). Comparisons were in relation to Montgomery-Asberg depression rating scale (MADRS) score reduction at weeks 1 (5 RCTs), 4 (5 RCTs), 6 (4 RCTs), 8 (5 RCTs), and 24 (1 RCT); proportion of responders at weeks 2, 4, 6 (2 RCTs for each time point), 8 (5 RCTs), and 24 (1 RCT); clinical global impression-severity (CGI-S) reduction at weeks 6 (1 RCT), 8 (5 RCTs), and 24 (1 RCT), and discontinuation due to adverse events or inefficacy during short-term (up to 8 weeks) and medium-term (24 weeks) treatment. ----- Results. MADRS reduction was greater with escitalopram, but 95% confidence intervals (CI) around the mean difference were entirely or largely below 2 scale points (minimally important difference) and CI around the effect size (ES) was below 0.32 ("small") at all time points. Risk of response was higher with escitalopram at week 8 (relative risk, 1.14; 95% CI, 1.04 to 1.26) but number needed to treat was 14 (95% CI, 7 to 111). All 95% CIs around the mean difference and ES of CGI-S reduction at week 8 were below 0.32 points and the limit of "small," respectively. Data for severe patients (MADRS>/=30) are scarce (only 1 RCT), indicating somewhat greater efficacy (response rate and MADRS reduction at week 8, but not CGI-S reduction) of escitalopram, but without compelling evidence of clinically relevant differences. Discontinuations due to adverse events or inefficacy up to 8 weeks of treatment were comparable. Data for the period up to 24 weeks are scarce and inconclusive. ----- Conclusion. Presently, the claims about clinically relevant superiority of escitalopram over citalopram in short-to-medium term treatment of major depressive disorder are not supported by evidence.

• Keywords (english): Adolescent; Adult; Aged; Antidepressive Agents, Second-Generation / pharmacology; Antidepressive Agents, Second-Generation / therapeutic use; Citalopram / pharmacology; Citalopram / therapeutic use; Depressive Disorder, Major / drug therapy; Humans; Middle Aged; Randomized Controlled Trials as Topic; Treatment Outcome; Young Adult
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 51, no. 1, pp. 61-73
• p-ISSN: 0353-9504
• DOI: https://doi.org/10.3325/cmj.2010.51.61
• URN:NBN: urn:nbn:hr:105:205213
• Publication: 2010-02-15
• Document URL: http://www.cmj.hr/2010/51/1/20162747.htm
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 11:31:20