The clinical effectiveness of using a predictive algorithm to guide antidepressant treatment in primary care (PReDicT): an open-label, randomised controlled trial.
The clinical effectiveness of using a predictive algorithm to guide antidepressant treatment in primary care (PReDicT): an open-label, randomised controlled trial.
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在初级保健中使用预测算法指导抗抑郁药物治疗的临床效果(预测)：一项开放标签的随机对照试验。
DOI：
10.1038/s41386-021-00981-z
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Dawson GR
中科院分区：
文献类型：
--
作者：
Browning M;Bilderbeck AC;Dias R;Dourish CT;Kingslake J;Deckert J;Goodwin GM;Gorwood P;Guo B;Harmer CJ;Morriss R;Reif A;Ruhe HG;van Schaik A;Simon J;Sola VP;Veltman DJ;Elices M;Lever AG;Menke A;Scanferla E;Stäblein M;Dawson GR
抑郁症患者通常对处方的第一种抗抑郁药没有反应，导致不同药物的连续试验。个体化药物提供了一种减少这种延迟的方法;然而，抗抑郁治疗的个体化方法的临床有效性以前没有经过测试。我们评估了使用预测算法的临床有效性，基于情感认知和主观症状的行为测试，以指导抗抑郁药治疗。我们在913名无药物治疗的抑郁症患者中进行了一项多中心、开放标签、随机对照试验。患者被随机分配接受预测算法指导的抗抑郁治疗或常规治疗（TaU）。主要结局是抑郁症状的缓解，定义为第8周QIDS-SR-16量表基线评分降低50%或以上。其他预先规定的结局包括第8周的焦虑症状，以及第8、24和48周的抑郁症状和功能结局。PReDicT（55.9%）和TaU（51.8%）组第8周抑郁症状的缓解率无显著差异（比值比：1.18（95% CI：0.89-1.56），P = 0.25）。然而，有一个显着更大的减少焦虑在第8周和更大的改善功能的结果在第24周的PReDicT手臂。使用PReDicT测试并没有增加抗抑郁药治疗的反应率估计抑郁症状，但改善焦虑症状在第8周和功能结果在第24周。我们的研究结果表明，个性化的抗抑郁治疗可能会改善抑郁症患者的预后。
Depressed patients often do not respond to the first antidepressant prescribed, resulting in sequential trials of different medications. Personalised medicine offers a means of reducing this delay; however, the clinical effectiveness of personalised approaches to antidepressant treatment has not previously been tested. We assessed the clinical effectiveness of using a predictive algorithm, based on behavioural tests of affective cognition and subjective symptoms, to guide antidepressant treatment. We conducted a multicentre, open-label, randomised controlled trial in 913 medication-free depressed patients. Patients were randomly assigned to have their antidepressant treatment guided by a predictive algorithm or treatment as usual (TaU). The primary outcome was the response of depression symptoms, defined as a 50% or greater reduction in baseline score of the QIDS-SR-16 scale, at week 8. Additional prespecified outcomes included symptoms of anxiety at week 8, and symptoms of depression and functional outcome at weeks 8, 24 and 48. The response rate of depressive symptoms at week 8 in the PReDicT (55.9%) and TaU (51.8%) arms did not differ significantly (odds ratio: 1.18 (95% CI: 0.89–1.56), P = 0.25). However, there was a significantly greater reduction of anxiety in week 8 and a greater improvement in functional outcome at week 24 in the PReDicT arm. Use of the PReDicT test did not increase the rate of response to antidepressant treatment estimated by depressive symptoms but did improve symptoms of anxiety at week 8 and functional outcome at week 24. Our findings indicate that personalisation of antidepressant treatment may improve outcomes in depressed patients.
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影响因子：
17.7
作者：
Harmer, Catherine J.;O'Sullivan, Ursula;Cowen, Philip J.
通讯作者：
Cowen, Philip J.
DOI：
10.1176/appi.focus.16407
发表时间：
2018-10-01
期刊：
Focus (American Psychiatric Publishing)
影响因子：
--
作者：
Cipriani, Andrea;Furukawa, Toshi A;Geddes, John R
通讯作者：
Geddes, John R
影响因子：
4.7
作者：
Harmer, Catherine J.
通讯作者：
Harmer, Catherine J.
影响因子：
4.8
作者：
Greden, John F.;Parikh, Sagar V.;Dechairo, Bryan
通讯作者：
Dechairo, Bryan
影响因子：
64.3
作者：
Chekroud, Adam Mourad;Zotti, Ryan Joseph;Corlett, Philip Robert
通讯作者：
Corlett, Philip Robert