Can C-reactive protein inform antidepressant medication selection in depressed outpatients? Findings from the CO-MED trial.
Can C-reactive protein inform antidepressant medication selection in depressed outpatients? Findings from the CO-MED trial.
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DOI：
10.1016/j.psyneuen.2017.01.023
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发表时间：
2017-04
影响因子：
3.7
通讯作者：
Trivedi MH
中科院分区：
文献类型：
--
作者：
Jha MK;Minhajuddin A;Gadad BS;Greer T;Grannemann B;Soyombo A;Mayes TL;Rush AJ;Trivedi MH
目前，没有有效的措施为抑郁症患者提供治疗选择。评估了C反应蛋白（CRP）和其他两种急性期反应物（炎症标志物）是否可以区分对两种不同作用机制治疗的患者。受试者包括联合用药增强抑郁结局（CO-MED）试验参与者，随机分配至艾司西酞普兰+安慰剂（SSRI单药治疗，n=51）或安非他酮+艾司西酞普兰联合治疗（安非他酮-SSRI联合治疗，n=55），基线血浆样本。使用Bioplex Pro™人急性期4重检测板测量CRP、血清淀粉样蛋白P组分和α-2-巨球蛋白。我们对CO-MED试验12周急性期每周或每隔一周获得的抑郁症状（抑郁症状自报快速量表）和副作用负担（副作用频率、强度和负担评定量表）进行混合模型分析，以评估这些结局与基线CRP和其他急性期反应物之间的关系。治疗组在抑郁症状或副作用结局方面没有差异。大多数参与者（69.8%，74/106）的基线CRP水平大于1 mg/L（表明全身炎症活动）。较高的基线CRP水平与安非他酮-SSRI联合治疗的抑郁严重程度较低相关（相关系数=-0.63），但与SSRI单药治疗无关（相关系数=0.40）。总缓解率为41.5%。基于CRP阈值分配（SSRI单药治疗<1 mg/L，安非他酮-SSRI ≥1 mg/L）的估计缓解率为53.1%，需要治疗的人数为8.6。副作用负荷与任何基线炎症标志物无关。基线CRP水平与抑郁症患者的抗抑郁治疗结果有差异。
Currently, no valid measures inform treatment selection for depressed patients. Whether C-reactive protein (CRP) in particular and two other acute phase reactants (inflammatory markers) could differentiate between patients responding to either of two treatments with different mechanisms of action was assessed. Subjects included Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants randomly assigned to either escitalopram plus placebo (SSRI monotherapy, n=51) or bupropion plus escitalopram combination (bupropion-SSRI combination, n=55) with baseline plasma samples. CRP, serum amyloid P component, and alpha-2-macroglobulin were measured using the Bioplex Pro™ human acute-phase 4-plex panel. We conducted mixed model analyses of depressive symptom (Quick Inventory of Depressive Symptomatology Self-Report) and side-effect burden (Frequency, Intensity, and Burden of Side-Effects Rating Scale) obtained weekly or every other week over the 12-week acute-phase of CO-MED trial to evaluate the relationship between these outcomes and baseline CRP and other acute-phase reactants. The treatment arms did not differ in depressive symptom or side effect outcomes. Most participants (69.8%, 74/106) had baseline CRP levels greater than 1 mg/L (indicative of systemic inflammatory activity). Higher baseline CRP levels were associated lower depression severity (correlation coefficient=−0.63) with bupropion-SSRI combination but not with SSRI monotherapy (correlation coefficient=0.40). The overall remission rate was 41.5%. The estimated remission rate with CRP threshold based assignment (SSRI monotherapy for <1 mg/L and Bupropion-SSRI for ≥1 mg/L) was 53.1%, with a number needed to treat of 8.6. Side effect burden was unrelated to any baseline inflammatory marker. Baseline CRP levels relate differentially to antidepressant treatment outcomes in persons with major depressive disorder.
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DOI：
10.1016/j.bbi.2015.06.001
发表时间：
2015-10
期刊：
Brain, behavior, and immunity
影响因子：
--
作者：
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通讯作者：
Kivimäki M
影响因子：
5.3
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Stratford, Robert E., Jr.
影响因子：
10.6
作者：
Dowlati, Yekta;Herrmann, Nathan;Lanctot, Krista L.
通讯作者：
Lanctot, Krista L.
影响因子：
15.9
作者：
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通讯作者：
Hirschfield, GM