A placebo prognostic index (PI) as a moderator of outcomes in the treatment of adolescent depression: Could it inform risk-stratification in treatment with cognitive-behavioral therapy, fluoxetine, or their combination?
A placebo prognostic index (PI) as a moderator of outcomes in the treatment of adolescent depression: Could it inform risk-stratification in treatment with cognitive-behavioral therapy, fluoxetine, or their combination?
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DOI：
10.1080/10503307.2020.1747657
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发表时间：
2020-03-31
影响因子：
3.9
通讯作者：
Weisz, John R.
中科院分区：
文献类型：
--
作者：
Lorenzo-Luaces, Lorenzo;Rodriguez-Quintana, Natalie;Weisz, John R.
简介：研究人员提出，预测谁是可能的安慰剂反应者可能有助于指导治疗分配到不同强度的治疗方案。研究方法：我们使用了来自青少年抑郁症治疗研究（TADS）的数据，其中青少年（n = 439）以1：1：1：1的比例随机接受安慰剂、认知行为治疗（CBT）、药物治疗（MED）或两者联合治疗（COMB）。我们在安慰剂组中开发了一个预后指数（PI），以预测自我报告（RADS）和自我评估（CDRS）抑郁症的结果，使用弹性网络正则化。我们探讨了PI是否在治疗条件下调节结果。结果：PI-CDRS可被多个变量预测，但不影响预后。PI-RADS可通过基线严重程度、年龄、睡眠问题、期望、母亲抑郁和变化的行动阶段进行预测。它调节了结局，使得安慰剂反应较低的患者存在治疗差异。对于倾向于安慰剂反应的参与者，治疗类型对结局没有统计学显著影响。基线抑郁严重程度解释了这种效应：轻度抑郁患者的治疗差异较小且不显著，但在更严重的抑郁患者中较大。讨论内容：未来的工作应该调查是否多个变量解释严重程度以外的结果，以及严重程度和其他变量之间的复杂相互作用。
Introduction: Researchers have proposed that predicting who is a likely placebo responder may help guide treatment allocations to treatment regimens that differ in intensity. Methods: We used data from the Treatment of Adolescent Depression Study (TADS) in which adolescents (n = 439) were randomized 1:1:1:1 to placebo, cognitive-behavioral therapy (CBT), medications (MEDs), or their combination (COMB). We developed a prognostic index (PI) in the placebo group to predict self-reported (RADS) and observer-rated (CDRS) depression outcomes using elastic net regularization. We explored whether the PIs moderated outcomes in the treatment conditions. Results: PI-CDRS was predicted by multiple variables but it did not moderate outcomes. PI-RADS was predicted by baseline severity, age, sleep problems, expectations, maternal depression, and the action stage of change. It moderated outcomes such that there were treatment differences for less placebo-responsive patients. For participants prone to placebo response, type of treatment had no statistically significant impact on outcomes. Baseline depression severity accounted for this effect: treatment differences were small and non-significant for patients with milder depression but larger in more severely depressed patients. Discussion: Future work should investigate whether multiple variable explain outcomes beyond severity as well as complex interactions between severity and other variables.