Meta-Analysis of Placebo Response in Adult Antidepressant Trials

doi:10.1007/s40263-019-00662-y

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	Meta-Analysis of Placebo Response in Adult Antidepressant Trials
	Li, Fenghua 1,2; Nasir, Madeeha 1; Olten, Baris 1; Bloch, Michael H.1,3
刊名	CNS DRUGS
	2019-10-01
页码	10
ISSN号	1172-7047
DOI	10.1007/s40263-019-00662-y
通讯作者	Bloch, Michael H.(michael.bloch@yale.edu)
英文摘要	Background Roughly 80% of the symptom improvement experienced on antidepressants in clinical trials is also observed in the placebo comparison group. Understanding the correlates of placebo improvement and response is important to designing efficient and successful trials of future antidepressants. Objective The objective of this meta-analysis was to investigate the magnitude of placebo symptom improvement and placebo response rates in second-generation antidepressant trials of depression, anxiety, and obsessive-compulsive disorder. Methods We searched PubMed on 10 June, 2016, with no date or language limits, to identify randomized placebo-controlled trials of second-generation antidepressants in adults with depression, anxiety, or obsessive-compulsive disorder. We used a random-effects meta-analysis to examine the magnitude of placebo symptom improvement using standardized mean difference and placebo response rate. Stratified subgroup analysis and meta-regression were utilized to examine the effect of diagnostic indication and correlates of placebo symptom improvement. Results The meta-analysis included 164 trials involving 19,591 participants. Magnitude of placebo improvement and placebo response rates varied significantly between diagnostic indications. The magnitude of placebo improvement was much lower in obsessive-compulsive disorder (standardized mean difference = 0.58, 95% confidence interval 0.36-0.79) than in depression (standardized mean difference = 1.22, 95% confidence interval 1.12-1.32) or anxiety (standardized mean difference = 1.01, 95% confidence interval 0.90-1.12) trials. There was a large amount of heterogeneity in placebo improvement between studies (Q = 899, df = 110, p < 0.001, I-2 = 88%). A greater number of study sites and a later publication year were associated with a greater magnitude of placebo improvement and response rate. Presence of a placebo lead-in and absence of non-US sites were associated with a reduced magnitude of placebo improvement. Trial duration was positively associated with the magnitude of placebo improvement in depression trials but negatively associated with the magnitude of placebo improvement in anxiety and obsessive-compulsive disorder trials. Conclusions Magnitude of placebo symptom improvement differed significantly based on diagnostic indication with improvement being significantly less in obsessive-compulsive disorder than anxiety and depression. Some trial characteristics were associated with a greater magnitude of placebo improvement in trials across disorders but others were disorder specific.
WOS关键词	MAJOR DEPRESSION ; DOUBLE-BLIND ; ANXIETY ; ESCITALOPRAM ; DISORDERS ; SEROTONIN ; EFFICACY
WOS研究方向	Neurosciences & Neurology ; Pharmacology & Pharmacy ; Psychiatry
语种	英语
出版者	ADIS INT LTD
WOS记录号	WOS:000488899600002
内容类型	期刊论文
源URL	[http://ir.psych.ac.cn/handle/311026/30152]
专题	心理研究所_中国科学院心理健康重点实验室
通讯作者	Bloch, Michael H.
作者单位	1.Yale Univ, Yale Child Study Ctr, Sch Med, 230 S Frontage Rd, New Haven, CT 06520 USA 2.Chinese Acad Sci, Inst Psychol, Key Lab Mental Hlth, 211 South Block,16 Lincui Rd, Beijing 100101, Peoples R China 3.Yale Univ, Sch Med, Yale Dept Psychiat, 333 Cedar St, New Haven, CT 06520 USA
推荐引用方式 GB/T 7714	Li, Fenghua,Nasir, Madeeha,Olten, Baris,et al. Meta-Analysis of Placebo Response in Adult Antidepressant Trials[J]. CNS DRUGS,2019:10.
APA	Li, Fenghua,Nasir, Madeeha,Olten, Baris,&Bloch, Michael H..(2019).Meta-Analysis of Placebo Response in Adult Antidepressant Trials.CNS DRUGS,10.
MLA	Li, Fenghua,et al."Meta-Analysis of Placebo Response in Adult Antidepressant Trials".CNS DRUGS (2019):10.