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Escitalopram and duloxetine in the treatment of major depressive disorder: a pooled analysis of two trials

Lam, Raymond W.a; Andersen, Henning F.b; Wade, Alan G.c

International Clinical Psychopharmacology: July 2008 - Volume 23 - Issue 4 - p 181-187
doi: 10.1097/YIC.0b013e3282ffdedc
ORIGINAL ARTICLES
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Pooled analyses have shown that escitalopram has superior effectiveness versus all comparators, including selective serotonin reuptake inhibitors and venlafaxine. Recent studies have compared escitalopram with duloxetine. Data from two randomized, double-blind studies that compared escitalopram (10–20 mg/day) and duloxetine (60 mg/day) were pooled and analysed for all patients and for the subsample of severely depressed patients [baseline Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥30]. Escitalopram (n=280) was superior to duloxetine (n=284) with respect to mean change from baseline in MADRS score at weeks 1, 2, 4 and 8 with a mean treatment difference at week 8 of 2.6 points (P<0.01). Similar results were seen for severely depressed patients, with a mean treatment difference of 3.7 points (P<0.01). Response and remission rates at week 8 were significantly higher for patients treated with escitalopram [response 67.1% for escitalopram compared with 53.2% for duloxetine, P<0.001; remission (MADRS≤12) 54.3% for escitalopram compared with 44.4% for duloxetine, P<0.05]. The numbers needed to treat based on response and remission rates, in favour of escitalopram, were 8 and 11, respectively, for all patients (6 and 7, respectively, for severely depressed patients). Significantly fewer (P<0.001) patients (all cause and owing to adverse events) withdrew from the escitalopram group. This pooled analysis shows that over an 8-week treatment period, escitalopram (10–20 mg/day) is superior in both effectiveness and tolerability compared with duloxetine (60 mg/day).

aDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada

bDepartment of Biostatistics, H. Lundbeck A/S, Copenhagen, Denmark

cCPS Clinical Research Centre, Glasgow, Scotland, UK

Correspondence to Dr Raymond W. Lam, MD, FRCPC, Department of Psychiatry, University of BC, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada

Tel: +1 604 822 7325; fax: +1 604 822 7922; e-mail: r.lam@ubc.ca

Present address of the author Henning F. Andersen: Novo Nordisk A/S, Krogshøjvej 51 2880 Bagsvaerd, Denmark.

Received 13 October 2007 Accepted 6 March 2008

© 2008 Lippincott Williams & Wilkins, Inc.