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| |  Escitalopram Effectively Prevents Relapse of Major Depressive Disorder in the Elderly, Regardless of Age: Presented at AAGP By Carole VanSickle Ellis SAVANNAH, Ga -- March 7, 2010 -- Escitalopram effectively induces remission and prevents relapse of major depressive disorder (MDD) in the elderly, regardless of age, according to findings presented here at the 2010 Annual Meeting of the American Association for Geriatric Psychiatry (AAGP). The results indicate that doctors can expect comparable rates of remission in their young-old and old-old patients and that both groups should demonstrate similar -- and low -- rates of relapse on this medication. In the study, headed by Constantine Lyketsos, MD, Johns Hopkins University, Baltimore, Maryland, researchers conducted a secondary analysis of a previously published trial to compare escitalopram in preventing MDD relapse among young-old (aged 60-75 y) and old-old (aged >75 y) patients. The findings, presented March 6, indicate that escitalopram is effective, regardless of age. Young-old (n = 254) and old-old (n = 151) patients with moderate or severe MDD received open-label escitalopram 10 or 20 mg/day for 12 weeks. Those who achieved remission, defined as a Montgomery-Asberg Depression Rating Scale (MADRS) score of <=12, were then randomised to continue their escitalopram regimen or to placebo for an additional 24 weeks. After the open-label treatment phase, 77.6% of young-old patients and 71.5% of old-old patients achieved remission and entered the double-blind, randomised phase. However, significantly more young-old patients achieved complete remission (MADRS <=5) after the first treatment period than the old-old patients (48.4% vs 35.1%; P = .01), the team reported. Dr. Lyketsos noted that the significantly higher percentage of young-old patients achieving total remission could be due in part to the fact that the old-old patients tended to have slightly more severe depressive symptoms at baseline. Relapse rates were significantly better with escitalopram compared with placebo. The placebo group had a hazard ratio of 4.4 (P < .001) for relapse, versus escitalopram. In addition, age had no impact on relapse, with a hazard ratio of 1.2 (P = .520) for old-old versus young-old patients. Only 6.9% of the young-old group and 12% of the old-old group treated with escitalopram relapsed. In the placebo group, 31.6% of the young-old and 34.5% of the old-old patients relapsed. Tolerability findings indicate that the old-old tolerate escitalopram treatment as well as young-old patients. During the 24-week, randomised period, 5 young-old and 4 old-old patients withdrew due to adverse events (AEs). Most AEs were mild to moderate, with headache (8.1%), dizziness (5.6%), and diarrhoea (5.1%) being the most commonly reported AEs in the young-old group, and headache (3.7%), dizziness (6.5%), hypertension (4.6%), and nasopharyngitis (4.6%) the most commonly reported AEs in the old-old group. The research team concluded that escitalopram could be expected to significantly lower the risk of relapse in both young-old and old-old patients with MDD and that both age groups had significant, successful remission rates. This original trial was funded by Lundbeck A/S. [Presentation title: Are Old-Old Patients With MDD More Likely to Relapse Than the Young-Old After Open-Label Treatment With Escitalopram? Abstract NR11]
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