By Judith Moser, MD
BARCELONA, Spain -- September 2, 2008 -- According to a pooled analysis of 2 randomised studies, escitalopram is more effective and safer in the long-term treatment of major depressive disorder compared with paroxetine.
Siegfried Kasper, MD, Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria, presented a pooled analysis of 2 studies comparing these 2 agents here on September 1 at the 21st European College of Neuropsychopharmacology Congress (ECNP).(1,2)
Both studies were randomised, controlled, 6-month trials. A total of 394 patients was treated with at least 1 dose of escitalopram 10 mg QD for the first week, with the first dose increased to 20 mg after 1 or 2 weeks. A total of 383 patients received at least 1 dose of paroxetine 20 mg QD for the first week, with the first dose increased to 40 mg after 1 week.
The primary efficacy assessment was the Montgomery-Asberg Depression Rating Scale (MADRS) total score. Secondary outcome measures included the response to treatment and remission rate at the end of the study.
At the study endpoint, escitalopram resulted in a significantly greater reduction in the MADRS score from baseline compared with paroxetine, with a mean difference of 2.0 points (P .01).
The differences according to the Clinical Global Impression-Severity (CGI-S) scale and the Clinical Global Impression-Improvement (CGI-I) scale were 0.26 (P .01) and 0.22 (P .01), respectively, in favour of escitalopram.
Escitalopram-treated patients showed a greater overall response rate at the end of the study compared with paroxetine-treated participants (83.0% vs 76.8%).
With increasing symptom severity at baseline, the magnitude of the treatment difference between the 2 agents became significantly greater.
In the subgroup of severely depressive patients (MADRS >= 30 points), the analysis revealed an advantage of escitalopram over paroxetine in terms of response (82.6% vs 75.7%). The change from baseline in MADRS score was larger for escitalopram in this subgroup after 6 months, with a mean treatment difference of 2.6 points (P .01).
In the total population, remission rates (defined as MADRS total score 12 or <= 10 points) were higher for patients treated with escitalopram after 6 months (MADRS <= 10 points; 70.8% vs 62.9%; P .01).
All MADRS items showed a difference in favour of escitalopram. In the severely ill population, the differences were more pronounced, reaching statistical difference for all 10 items.
"The explanation for the favourable efficacy of escitalopram may be the very specific allosteric binding to the serotonin transporter, which means that it binds more tightly," Dr. Kasper explained.
Withdrawal rates were significantly lower in the escitalopram group for the entire study period (P .001). Withdrawals due to adverse events occurred in 6.6% with escitalopram and in 11.7% with paroxetine (P .01).
Funding for this study was provided by Lundbeck A/S.
1. Baldwin DS et al. Int Clin Psychopharmacol. 2006;21:159-169.
2. Boulenger JP et al. Curr Med Res Opin. 2006;22:1331-1341.
[Presentation title: Pooled analysis: 2 Randomised Clinical Trials Confirm Superiority of Escitalopram Over Paroxetine in Treatment of MDD. Abstract P2a009]
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