Prediction of Long-Term Remission in Major Depressive Disorder Allows for Early Treatment Adjustments: Presented at ECNP

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Title: Prediction of Long-Term Remission in Major Depressive Disorder Allows for Early Treatment Adjustments: Presented at ECNP
URL: http://www.pslgroup.com/dg/22AC82.htm
Doctor's Guide
September 4, 2008

By Judith Moser, MD

BARCELONA, Spain -- September 2, 2008 -- Factors associated with an increased likelihood of achieving remission in major depressive disorder include onset of response at week 2, response at week 8, completion of a 6-month treatment course, and treatment with escitalopram, according to results presented here at the 21st European College of Neuropsychopharmacology Congress (ECNP).

The pooled analysis included 4 previously published, randomised, controlled, 6-month trials on treatment with escitalopram and 3 active comparators in major depressive disorder.(1-4)

"What we were interested in was the outcome of patients relative to how they perform early on," said Alan Wade, MD, CPS Clinical Research Centre, Glasgow, Scotland, in a poster session on September 1.

According to pre-existing data, an early onset of response at 2 weeks is linked to a positive outcome. "Clinically, if patients haven't responded at that time, a change in treatment might improve the long-term outcome," Dr. Wade said.

Treatment groups comprised 699 patients treated with escitalopram, 146 with duloxetine, 174 with citalopram, and 379 with paroxetine.

Response was measured with the Montgomery-Asberg Depression Rating Scale (MADRS), with onset of response after 2 weeks of treatment defined as a decrease of 20% or greater from baseline. Response was defined as a decrease of 50% or greater.

"Escitalopram performed better than the drugs it was compared against," Dr. Wade reported. The overall remission rate (MADRS total score <= 10) was greater for escitalopram compared with the pooled comparators (70.7% vs 64.7%, respectively; P .01).

Onset of response at week 2 correlated significantly with response at week 8, thus confirming the previous findings. Eighty percent of the participants achieving onset of response at week 2 responded by week 8, whereas response by week 8 was reported in a smaller proportion of the patients with no onset of response at week 2 (43.2% vs 35.6%, respectively; P .0001 for group difference).

The probability of achieving remission (MADRS <=10) and complete remission (MADRS <=5) at 6 months was significantly greater for patients who had achieved a response by week 8 across the treatment groups (P .0001 for difference between week-8 groups).

Thus, response after 8 weeks was more highly associated with achieving remission than was completing 6 months of treatment.

Response by week 8 was correlated with a greater probability of completing 6 months of treatment. Among patients who responded by week 8, 93.9% of patients in the escitalopram group and 88.6% of those in the comparator group completed the 6-month treatment course compared with 84.3% and 75.6%, respectively, of patients who did not achieve a response at week 8 and who did complete the treatment course (P .0001 between treatment groups).

Funding for this study was provided by H. Lundbeck A/S.

1. Colonna L et al. Curr Med Res Opin. 2005;21:1659-1668.

2. Baldwin DS et al. Int Clin Psychopharmacol. 2006;21:159-169.

3. Boulenger JP et al. Curr Med Res Opin. 2006;22:1331-1341.

4. Wade AG et al. Curr Med Res Opin. 2007;23:1605-1614.

[Presentation title: Treatment Milestones Predict Symptom Remission Over 6-Month Treatment of Patients With Major Depressive Disorder. Abstract P2a002]

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