Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis.
Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis.
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DOI：
10.1136/bmjopen-2015-010919
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发表时间：
2016-07-08
期刊：
影响因子：
2.9
通讯作者：
Cipriani A
中科院分区：
文献类型：
--
作者：
Furukawa TA;Salanti G;Atkinson LZ;Leucht S;Ruhe HG;Turner EH;Chaimani A;Ogawa Y;Takeshima N;Hayasaka Y;Imai H;Shinohara K;Suganuma A;Watanabe N;Stockton S;Geddes JR;Cipriani A
许多抗抑郁药用于治疗重度抑郁症。两个网络荟萃分析提供了迄今为止最全面的评估，包括直接和间接比较；然而，这些报告的结果相互矛盾的解释。在这里，我们提出了一个系统回顾和网络荟萃分析的方案，旨在更新证据基础，比较所有第二代和选定的第一代抗抑郁药在严重抑郁症急性治疗中的疗效和可接受性。我们将纳入所有报告为双盲的随机对照试验，并将一种有效药物与另一种药物或安慰剂在成人重度抑郁症的急性期治疗中进行比较。我们有兴趣比较以下活性剂：阿戈美拉汀、阿米替林、安非他酮、西酞普兰、氯米帕明、地文拉法辛、度洛西汀、艾司西酞普兰、氟西汀、氟伏沙明、左米那西普兰、米那西普兰、奈法唑酮、帕罗西汀、瑞波西汀、舍曲林、曲唑酮、文拉法辛、维拉唑酮和沃替西汀。主要结果将是对分配的治疗有反应或退出治疗的患者比例。已发表和未发表的研究将通过相关数据库检索、试验登记和网站进行检索；所有文献选择和数据提取将由至少两名独立审稿人进行。我们将进行随机效应网络荟萃分析，以综合每个结果的所有证据，并获得所有治疗的综合排名。为了对每个结果的各种治疗进行排名，我们将使用累积排名曲线下的表面和平均排名。我们将采用本地和全球的方法来评估一致性。我们将使用OpenBUGS在贝叶斯框架中拟合我们的模型，并在Stata和r中生成结果和各种检查。我们还将使用GRADE框架评估有助于网络估计主要结果的证据的质量。此审查不需要伦理批准。CRD42012002291。
Many antidepressants are indicated for the treatment of major depression. Two network meta-analyses have provided the most comprehensive assessments to date, accounting for both direct and indirect comparisons; however, these reported conflicting interpretation of results. Here, we present a protocol for a systematic review and network meta-analysis aimed at updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. We will include all randomised controlled trials reported as double-blind and comparing one active drug with another or with placebo in the acute phase treatment of major depression in adults. We are interested in comparing the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will be the proportion of patients who responded to or dropped out of the allocated treatment. Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. To rank the various treatments for each outcome, we will use the surface under the cumulative ranking curve and the mean ranks. We will employ local as well as global methods to evaluate consistency. We will fit our model in a Bayesian framework using OpenBUGS, and produce results and various checks in Stata and R. We will also assess the quality of evidence contributing to network estimates of the main outcomes with the GRADE framework. This review does not require ethical approval. CRD42012002291.