Original scientific paper
Is Escitalopram Really Relevantly Superior to Citalopram in Treatment of Major Depressive Disorder? A Meta-analysis of Head-tohead Randomized Trials
Vladimir Trkulja
; Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
Abstract
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
escitalopram; citalopram; major depressive disorder; efficacy
Hrčak ID:
53508
URI
Publication date:
15.2.2010.
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