Depression symptom clusters and their predictive value for treatment outcomes: Results from an individual patient data meta-analysis of duloxetine trials
Identifieur interne : 004215 ( Main/Exploration ); précédent : 004214; suivant : 004216Depression symptom clusters and their predictive value for treatment outcomes: Results from an individual patient data meta-analysis of duloxetine trials
Auteurs : Alexander Schacht [Allemagne] ; Philip Gorwood [France] ; Philip Boyce [Australie] ; Ayal Schaffer [Canada] ; Hernan Picard [Royaume-Uni]Source :
- Journal of psychiatric research [ 0022-3956 ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
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Abstract
We evaluated individual patient data from phase II to IV clinical trials of duloxetine in major depressive disorder (MDD) (34 studies, 13,887 patients). Our goal was to identify clusters of patients with similar depressive symptom patterns at baseline, as measured by the 17-item Hamilton Depression Rating Scale (HAMD-17), and to investigate their respective predictive value of outcomes as measured by the HAMD-17 total score. Five clusters were identified at baseline: 1) "Lack of insight"; 2) "Sleep/sexual/somatic"; 3) "Typical MDD"; 4) "Gastrointestinal/weight loss"; and 5) "Mild MDD". However, it should be noted that cluster descriptors are not mutually exclusive. Analyses of the HAMD-17 total score results over time were performed using the 18 randomized placebo and/or actively controlled studies representing 6723 patients. At the end of acute treatment (ranging from 4 to 36 weeks), different levels of effect sizes for active therapy (64.5% duloxetine) vs. placebo were detected by cluster. In 3 out of 5 clusters (representing about 80% of the patients), the effect size was significantly different from 0, in favor of active therapy. The effect size was largest in those clusters with severe somatic symptoms ("Sleep/sexual/somatic" cluster [-0.4170], and "Gastrointestinal/weight loss" cluster [-0.338]). In conclusion, our cluster analysis identified 5 clinically relevant MDD patient clusters with specific mean treatment outcomes. Identification of MDD clusters may help to improve outcomes by adapting MDD treatment to particular clinical profiles. .
Affiliations:
- Allemagne, Australie, Canada, France, Royaume-Uni
- Angleterre, Grand Londres, Nouvelle-Galles du Sud, Ontario, Île-de-France
- Londres, Paris, Sydney, Toronto
- Université de Sydney, Université de Toronto
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type="wicri:Area/Main/Curation">004215</idno><idno type="wicri:Area/Main/Exploration">004215</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Depression symptom clusters and their predictive value for treatment outcomes: Results from an individual patient data meta-analysis of duloxetine trials</title><author><name sortKey="Schacht, Alexander" sort="Schacht, Alexander" uniqKey="Schacht A" first="Alexander" last="Schacht">Alexander Schacht</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Lilly Deutschland GmbH, Global Statistical Sciences</s1><s2>Bad Homburg</s2><s3>DEU</s3><sZ>1 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Bad Homburg</wicri:noRegion><wicri:noRegion>Global Statistical Sciences</wicri:noRegion><wicri:noRegion>Bad Homburg</wicri:noRegion></affiliation></author><author><name sortKey="Gorwood, Philip" sort="Gorwood, Philip" uniqKey="Gorwood P" first="Philip" last="Gorwood">Philip Gorwood</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Sainte-Anne Hospital (CMME), Paris Descartes University, INSERM UMR894</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Boyce, Philip" sort="Boyce, Philip" uniqKey="Boyce P" first="Philip" last="Boyce">Philip Boyce</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>University of Sydney, Sydney Medical School, Discipline of Psychiatry</s1><s2>Sydney, NSW</s2><s3>AUS</s3><sZ>3 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Westmead Hospital, Department of Psychiatry</s1><s2>Wentorthville, NSW</s2><s3>AUS</s3><sZ>3 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Wentorthville, NSW</wicri:noRegion></affiliation></author><author><name sortKey="Schaffer, Ayal" sort="Schaffer, Ayal" uniqKey="Schaffer A" first="Ayal" last="Schaffer">Ayal Schaffer</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>University of Toronto, Sunnybrook Health Sciences Centre, Department of Psychiatry</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, ON</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Picard, Hernan" sort="Picard, Hernan" uniqKey="Picard H" first="Hernan" last="Picard">Hernan Picard</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>21 Chesterford Gardens, NW3 7DD</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of psychiatric research</title><title level="j" type="abbreviated">J. psychiatr. res.</title><idno type="ISSN">0022-3956</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of psychiatric research</title><title level="j" type="abbreviated">J. psychiatr. res.</title><idno type="ISSN">0022-3956</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antidepressant agent</term><term>Automatic classification</term><term>Data analysis</term><term>Depression</term><term>Depression Rating Scale Hamilton</term><term>Duloxetine</term><term>Evaluation scale</term><term>Human</term><term>Metaanalysis</term><term>Predictive factor</term><term>Psychotropic</term><term>Review</term><term>Symptomatology</term><term>Treatment efficiency</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Etat dépressif</term><term>Symptomatologie</term><term>Facteur prédictif</term><term>Efficacité traitement</term><term>Analyse donnée</term><term>Métaanalyse</term><term>Article synthèse</term><term>Duloxétine</term><term>Classification automatique</term><term>Depression Rating Scale Hamilton</term><term>Echelle d'évaluation</term><term>Homme</term><term>Psychotrope</term><term>Antidépresseur</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We evaluated individual patient data from phase II to IV clinical trials of duloxetine in major depressive disorder (MDD) (34 studies, 13,887 patients). Our goal was to identify clusters of patients with similar depressive symptom patterns at baseline, as measured by the 17-item Hamilton Depression Rating Scale (HAMD-17), and to investigate their respective predictive value of outcomes as measured by the HAMD-17 total score. Five clusters were identified at baseline: 1) "Lack of insight"; 2) "Sleep/sexual/somatic"; 3) "Typical MDD"; 4) "Gastrointestinal/weight loss"; and 5) "Mild MDD". However, it should be noted that cluster descriptors are not mutually exclusive. Analyses of the HAMD-17 total score results over time were performed using the 18 randomized placebo and/or actively controlled studies representing 6723 patients. At the end of acute treatment (ranging from 4 to 36 weeks), different levels of effect sizes for active therapy (64.5% duloxetine) vs. placebo were detected by cluster. In 3 out of 5 clusters (representing about 80% of the patients), the effect size was significantly different from 0, in favor of active therapy. The effect size was largest in those clusters with severe somatic symptoms ("Sleep/sexual/somatic" cluster [-0.4170], and "Gastrointestinal/weight loss" cluster [-0.338]). In conclusion, our cluster analysis identified 5 clinically relevant MDD patient clusters with specific mean treatment outcomes. Identification of MDD clusters may help to improve outcomes by adapting MDD treatment to particular clinical profiles. .</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Canada</li><li>France</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Paris</li><li>Sydney</li><li>Toronto</li></settlement><orgName><li>Université de Sydney</li><li>Université de Toronto</li></orgName></list><tree><country name="Allemagne"><noRegion><name sortKey="Schacht, Alexander" sort="Schacht, Alexander" uniqKey="Schacht A" first="Alexander" last="Schacht">Alexander Schacht</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Gorwood, Philip" sort="Gorwood, Philip" uniqKey="Gorwood P" first="Philip" last="Gorwood">Philip Gorwood</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Boyce, Philip" sort="Boyce, Philip" uniqKey="Boyce P" first="Philip" last="Boyce">Philip Boyce</name></region><name sortKey="Boyce, Philip" sort="Boyce, Philip" uniqKey="Boyce P" first="Philip" last="Boyce">Philip Boyce</name></country><country name="Canada"><region name="Ontario"><name sortKey="Schaffer, Ayal" sort="Schaffer, Ayal" uniqKey="Schaffer A" first="Ayal" last="Schaffer">Ayal Schaffer</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Picard, Hernan" sort="Picard, Hernan" uniqKey="Picard H" first="Hernan" last="Picard">Hernan Picard</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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