Wade A G, Schlaepfer T E, Andersen H F, Kilts C D
CPS Clinical Research Centre, Glasgow, United Kingdom.
J Psychiatr Res. 2009 Feb;43(5):568-75. doi: 10.1016/j.jpsychires.2008.09.008. Epub 2008 Oct 26.
It is uncertain as to what short-term outcomes predict long-term treatment compliance and outcomes in patients with MDD.
To determine what treatment milestones predict symptom remission with long-term treatment with antidepressant medication.
Pooled analysis of four randomised, double-blind, active comparator, 6-month trials in MDD.
Patients received double-blind treatment with escitalopram (N=699) or a comparator (citalopram, duloxetine, or paroxetine) (N=699). Onset of effect at week 2 was correlated with response at week 8, and response at week 8 with completion of 6-month treatment. Week 8 response was associated with a greater probability of achieving later remission. Week 24 remission (MADRS>or=10) was significantly (p<0.01) higher for patients treated with escitalopram (70.7%) than for the pooled comparators (64.7%). Week 24 complete remission (MADRS<or=5) was significantly (p<0.01) higher for escitalopram (51.7%) than for the pooled comparators (45.6%). Fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (p<0.001).
A higher probability of achieving remission is associated with responding after 8 weeks and with completing 6 months of treatment.
对于重度抑郁症（MDD）患者而言，哪些短期结果能够预测长期治疗依从性和治疗结果尚不确定。
确定哪些治疗节点能够预测抗抑郁药物长期治疗后的症状缓解情况。
对四项针对MDD患者的为期6个月的随机、双盲、活性对照试验进行汇总分析。
患者接受艾司西酞普兰（N = 699）或对照药物（西酞普兰、度洛西汀或帕罗西汀）（N = 699）的双盲治疗。第2周起效与第8周的反应相关，第8周的反应与6个月治疗的完成情况相关。第8周的反应与后期实现缓解的可能性更大相关。接受艾司西酞普兰治疗的患者在第24周缓解（蒙哥马利-艾斯伯格抑郁量表>MADRS≥10）的比例（70.7%）显著高于（p<0.01）合并的对照药物组（64.7%）。艾司西酞普兰组在第24周完全缓解（MADRS≤5）的比例（51.7%）显著高于（p<0.01）合并的对照药物组（45.6%）。与合并的对照药物组（23.9%）相比，艾司西酞普兰组停药的患者更少（15.9%）（p<0.001）。
实现缓解的较高概率与8周后出现反应以及完成6个月治疗相关。
