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| |  Prediction of Long-Term Remission in Major Depressive Disorder Allows for Early Treatment Adjustments: Presented at ECNP By Judith Moser, MD BARCELONA, Spain -- September 2, 2008 -- Factors associated with an increased likelihood of achieving remission in major depressive disorder include onset of response at week 2, response at week 8, completion of a 6-month treatment course, and treatment with escitalopram, according to results presented here at the 21st European College of Neuropsychopharmacology Congress (ECNP). The pooled analysis included 4 previously published, randomised, controlled, 6-month trials on treatment with escitalopram and 3 active comparators in major depressive disorder.(1-4) "What we were interested in was the outcome of patients relative to how they perform early on," said Alan Wade, MD, CPS Clinical Research Centre, Glasgow, Scotland, in a poster session on September 1. According to pre-existing data, an early onset of response at 2 weeks is linked to a positive outcome. "Clinically, if patients haven't responded at that time, a change in treatment might improve the long-term outcome," Dr. Wade said. Treatment groups comprised 699 patients treated with escitalopram, 146 with duloxetine, 174 with citalopram, and 379 with paroxetine. Response was measured with the Montgomery-Asberg Depression Rating Scale (MADRS), with onset of response after 2 weeks of treatment defined as a decrease of 20% or greater from baseline. Response was defined as a decrease of 50% or greater. "Escitalopram performed better than the drugs it was compared against," Dr. Wade reported. The overall remission rate (MADRS total score <= 10) was greater for escitalopram compared with the pooled comparators (70.7% vs 64.7%, respectively; P .01). Onset of response at week 2 correlated significantly with response at week 8, thus confirming the previous findings. Eighty percent of the participants achieving onset of response at week 2 responded by week 8, whereas response by week 8 was reported in a smaller proportion of the patients with no onset of response at week 2 (43.2% vs 35.6%, respectively; P .0001 for group difference). The probability of achieving remission (MADRS <=10) and complete remission (MADRS <=5) at 6 months was significantly greater for patients who had achieved a response by week 8 across the treatment groups (P .0001 for difference between week-8 groups). Thus, response after 8 weeks was more highly associated with achieving remission than was completing 6 months of treatment. Response by week 8 was correlated with a greater probability of completing 6 months of treatment. Among patients who responded by week 8, 93.9% of patients in the escitalopram group and 88.6% of those in the comparator group completed the 6-month treatment course compared with 84.3% and 75.6%, respectively, of patients who did not achieve a response at week 8 and who did complete the treatment course (P€ .0001 between treatment groups). Funding for this study was provided by H. Lundbeck A/S.
1. Colonna L et al. Curr Med Res Opin. 2005;21:1659-1668.
[Presentation title: Treatment Milestones Predict Symptom Remission Over 6-Month Treatment of Patients With Major Depressive Disorder. Abstract P2a002]
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