Dynamic prediction of treatment response in late-life depression.
Dynamic prediction of treatment response in late-life depression.
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DOI：
10.1016/j.jagp.2012.07.002
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发表时间：
2014-02
影响因子：
7.2
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
--
作者：
Joel, Ian;Begley, Amy E.;Mulsant, Benoit H.;Lenze, Eric J.;Mazumdar, Sati;Dew, Mary Amanda;Blumberger, Daniel;Butters, Meryl;Reynolds, Charles F., III
1)识别老年抑郁症患者抗抑郁药物治疗缓解的可行预测因子和2）使用信号检测理论开发决策树以指导临床决策。在NIMH赞助的随机、安慰剂对照的阿立哌唑强化试验中，我们使用开放标签的文拉法辛XR（高达300 mg/天）治疗了277名当前患有重度抑郁症的参与者12周。多元逻辑回归和信号检测方法确定了完成者和意向治疗样本中缓解的预测因子。基线抑郁症状严重程度较高（OR，0.86，95%CI，0.80-0.93; p <0.001），治疗前两周内症状改善较小（OR，0.96，95% CI，0.94-0.97; p <0.001），男性（OR，0.41 95%CI，0.18-0.93，p=0.03），当前发作持续时间≥ 2年（OR，0.26 95%CI，0.12-0.57，p<0.001）和充分的既往抑郁治疗（ATHF ≥ 3）（OR，0.34 95%CI，0.16-0.74，p=0.006）预测完成者样本中缓解的概率较低。前两周内蒙哥马利阿斯伯格（MADRS）下降>27%且基线MADRS评分<27（百分位数= 51）的受试者缓解的机会最大（89%）。在前2周内症状轻微减轻且既往接受过充分治疗且年龄小于75岁的受试者的缓解机会最低（16%）。我们的研究结果表明，测量治疗前疾病的严重程度和治疗前两周的变化在预测晚年抑郁症缓解的临床效用。
1) identify actionable predictors of remission to antidepressant pharmacotherapy in depressed older adults and 2) use signal detection theory to develop decision trees to guide clinical decision making We treated 277 participants with current major depression using open-label venlafaxine XR (up to 300 mg/day) for 12 weeks, in an NIMH-sponsored randomized, placebo-controlled augmentation trial of adjunctive aripiprazole. Multiple logistic regression and signal detection approaches identified predictors of remission in both completer and intent-to-treat samples. Higher baseline depressive symptom severity (OR, 0.86, 95% CI, 0.80-0.93; p <0.001), smaller symptom improvement during the first two weeks of treatment (OR, 0.96, 95% CI, 0.94-0.97; p <0.001), male sex (OR, 0.41 95% CI, 0.18-0.93, p=0.03), duration of current episode ≥ 2 years (OR, 0.26 95% CI, 0.12-0.57, p<0.001) and adequate past depression treatment (ATHF >=3) (OR, 0.34 95% CI, 0.16-0.74, p=0.006) predicted lower probability of remission in the completer sample. Subjects with Montgomery Asberg (MADRS) decreasing by >27% in the first two weeks and with baseline MADRS scores of <27 (percentile rank = 51) had the best chance of remission (89%). Subjects with small symptom decrease in the first 2 weeks with adequate prior treatment and younger than 75 yrs old had the lowest chance of remission (16%). Our results suggest the clinical utility of measuring pre-treatment illness severity and change during the first two weeks of treatment in predicting remission of late-life major depression.
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影响因子：
0.5
作者：
Kroenke, K;Spitzer, RL
通讯作者：
Spitzer, RL
影响因子：
4
作者：
Reynolds, Charles F., III;Dew, Mary Amanda;Martire, Lynn M.;Miller, Mark D.;Cyranowski, Jill M.;Lenze, Eric;Whyte, Ellen M.;Mulsant, Benoit H.;Pollock, Bruce G.;Karp, Jordan F.;Gildengers, Ariel;Szanto, Katalin;Dombrovski, Alexandre Y.;Andreescu, Carmen;Butters, Meryl A.;Morse, Jennifer Q.;Houck, Patricia R.;Bensasi, Salem;Mazumdar, Sati;Stack, Jacqueline A.;Frank, Ellen
通讯作者：
Frank, Ellen
影响因子：
5.9
作者：
BECK, AT;KOVACS, M;WEISSMAN, A
通讯作者：
WEISSMAN, A
影响因子：
7.2
作者：
Nelson, J. Craig;Delucchi, Kevin;Schneider, Lon S.
通讯作者：
Schneider, Lon S.
影响因子：
17.7
作者：
Andreescu, Carmen;Mulsant, Benoit H.;Reynolds, Charles F., III
通讯作者：
Reynolds, Charles F., III