Is Escitalopram Really Relevantly Superior to Citalopram in Treatment of Major Depressive Disorder? A Meta-analysis of Head-tohead Randomized Trials

摘要

Aim To evaluate clinical relevance of differences betweenescitalopram and citalopram (equimolar) for major depressivedisorder.Methods Review and meta-analysis of comparative randomizedcontrolled trials (RCT). Comparisons were in relationto 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 respondersat 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 inefficacyduring short-term (up to 8 weeks) and medium-term (24weeks) treatment.Results MADRS reduction was greater with escitalopram,but 95% confidence intervals (CI) around the mean differencewere entirely or largely below 2 scale points (minimallyimportant difference) and CI around the effect size(ES) was below 0.32 (“small”) at all time points. Risk of responsewas higher with escitalopram at week 8 (relativerisk, 1.14; 95% CI, 1.04 to 1.26) but number needed to treatwas 14 (95% CI, 7 to 111). All 95% CIs around the mean differenceand ES of CGI-S reduction at week 8 were below0.32 points and the limit of “small,” respectively. Data for severepatients (MADRS≥30) are scarce (only 1 RCT), indicatingsomewhat greater efficacy (response rate and MADRSreduction at week 8, but not CGI-S reduction) of escitalopram,but without compelling evidence of clinically relevantdifferences. Discontinuations due to adverse eventsor 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 relevantsuperiority of escitalopram over citalopram in short-to-mediumterm treatment of major depressive disorder are notsupported by evidence.