Relapse Prevention and Residual Symptoms: A Closer Analysis of Placebo-Controlled Continuation Studies With Escitalopram in Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Obsessive-Compulsive Disorder
Relapse Prevention and Residual Symptoms: A Closer Analysis of Placebo-Controlled Continuation Studies With Escitalopram in Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Obsessive-Compulsive Disorder
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DOI：
10.4088/jcp.08m04749blu
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发表时间：
2010-02-01
影响因子：
5.3
通讯作者：
Overo, Kerstin F.
中科院分区：
文献类型：
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作者：
Bech, Per;Lonn, Sara L.;Overo, Kerstin F.
目的：对来自4项艾司西酞普兰复发预防研究的数据进行了分析，以比较在双盲、24周持续期内有和无残留症状的患者的复发率和总体疾病。方法：临床总体印象-2005年至2007年发表的4项研究中的疾病严重程度评分和复发状态，各有1项针对重度抑郁症（MDD），广泛性焦虑症、社交焦虑症和强迫症（OCD）的患者，采用混合效应模型重复测量作为蒙哥马利-艾斯伯格抑郁评定量表（MADRS）评分的函数，在随机分组时对第1、3和7项进行分析。所有研究均显示有统计学意义（P0）且无残留症状（MADRS评分= 0），根据患者对MADRS的3个核心项目的评分定义：抑郁情绪（观察到的），内心或精神紧张，和倦怠。在随机化时，有残留症状的患者总体上比无此类症状的患者病情更严重。没有继续积极治疗的患者病情恶化，即使他们最初没有残留症状。相反，继续接受艾司西酞普兰治疗的患者保持稳定或进一步改善，无论残留症状或诊断如何。没有明确的图片出现关于是否有残留症状的患者有较高的复发率。结论：残留症状的存在与所有4个诊断组的整体疾病严重程度显着恶化，并与MDD或OCD患者复发的风险较高（虽然不显着）。所有研究中最大的差异是接受艾司西酞普兰治疗的患者（复发率接近20%）和安慰剂治疗的患者（复发率约为50%）。J Clin Psychiatry 2010;71（2）：121-129（C）Copyright 2010 Physicians Postgraduate Press，Inc.
Objective: Analyses of data from 4 relapse-prevention studies with escitalopram were conducted in order to compare patients with and without residual symptoms with regard to relapse rates and global illness during double-blind, 24-week continuation periods.Method: Clinical Global Impressions-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization.Results: All studies showed a statistically significant (P 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill than patients without such a symptom. Patients who did not continue active treatment worsened, even if they were initially free of a residual symptom. In contrast, patients who continued receiving escitalopram remained stable or further improved, regardless of residual symptoms or diagnosis. No clear picture emerged regarding whether patients with residual symptoms had a higher relapse rate.Conclusions: The presence of residual symptoms is associated with significantly worse overall illness severity in all 4 diagnostic groups and with a higher (although not significantly) risk of relapse for patients with MDD or OCD. The greatest difference in all of the studies was between patients treated with escitalopram (relapse rates similar to 20%) and placebo (relapse rates of about 50%). J Clin Psychiatry 2010;71(2):121-129 (C) Copyright 2010 Physicians Postgraduate Press, Inc.