The International Study to Predict Optimized Treatment in Depression (iSPOT-D): Outcomes from the acute phase of antidepressant treatment
The International Study to Predict Optimized Treatment in Depression (iSPOT-D): Outcomes from the acute phase of antidepressant treatment
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DOI：
10.1016/j.jpsychires.2014.12.018
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发表时间：
2015-02-01
影响因子：
4.8
通讯作者：
Williams, Leanne M.
中科院分区：
文献类型：
--
作者：
Saveanu, Radu;Etkin, Amit;Williams, Leanne M.
我们的目的是在一个实际的试验设计中描述一个大型的国际MDD门诊患者队列，以确定三种常见的抗抑郁药物在重度抑郁症（MDD）急性期治疗中临床有用的预后预测因子。国际抑郁症最佳治疗预测研究目前在17个研究中心（5个国家）招募了1008名寻求治疗的门诊患者（18-65岁）。在治疗前，我们通过症状、临床病史、功能状态和合并症来描述参与者的特征。参与者被随机分配接受艾司西酞普兰、舍曲林或文拉法辛缓释剂，并由他们的医生按照常规治疗方法进行管理。8周后评估症状、功能、生活质量和副作用结局。焦虑与反应和缓解的关系通过共病轴I诊断、焦虑症状的存在/不存在以及焦虑症状严重程度进行评估。样本有中度至重度症状，但有大量合并症和功能障碍。在第8周的完成者中，17项汉密尔顿抑郁量表的应答率和45.4%达到缓解; 16项抑郁症状快速量表的应答率和缓解率分别为53.3%和37.6%。在所有领域都看到了功能上的改进。大多数受试者的副作用发生频率为25%或更低，据报道，副作用的强度和负担在“无”至最小/轻度范围内。治疗前焦虑症状越严重，所有药物的缓解率越低，与抑郁严重程度、诊断合并症或副作用无关。在各种药物治疗中，我们发现症状和功能的改善一致且相似，以及共病焦虑症状的维度预后效应。这些治疗之间的等效结果为确定该样本中治疗结果的潜在神经生物学和遗传预测因子奠定了基础。(C)2014爱思唯尔有限公司版权所有。
We aimed to characterize a large international cohort of outpatients with MDD within a practical trial design, in order to identify clinically useful predictors of outcomes with three common antidepressant medications in acute-phase treatment of major depressive disorder (MDD). The international Study to Predict Optimized Treatment in Depression has presently enrolled 1008 treatment-seeking outpatients (18-65 years old) at 17 sites (five countries). At pre-treatment, we characterized participants by symptoms, clinical history, functional status and comorbidity. Participants were randomized to receive escitalopram, sertraline or venlafaxine-extended release and managed by their physician following usual treatment practices. Symptoms, function, quality of life, and side-effect outcomes were assessed 8 weeks later. The relationship of anxiety to response and remission was assessed by comorbid Axis I diagnosis, presence/absence of anxiety symptoms, and dimensionally by anxiety symptom severity. The sample had moderate-to-severe symptoms, but substantial comorbidity and functional impairment. Of completers at week 8, 62.2% responded and 45.4% reached remission on the 17-item Hamilton Rating Scale for Depression; 53.3% and 37.6%, respectively on the 16-item Quick Inventory of Depressive Symptoms. Functional improvements were seen across all domains. Most participants had side effects that occurred with a frequency of 25% or less and were reported as being in the "none" to minimal/mild range for intensity and burden.Outcomes did not differ across medication groups. More severe anxiety symptoms at pre-treatment were associated with lower remission rates across all medications, independent of depressive severity, diagnostic comorbidity or side effects. Across medications, we found consistent and similar improvements in symptoms and function, and a dimensional prognostic effect of comorbid anxiety symptoms. These equivalent outcomes across treatments lay the foundation for identifying potential neurobiological and genetic predictors of treatment outcome in this sample. (C) 2014 Elsevier Ltd. All rights reserved.