Li Guangjian, Wang Xu, Ma Dihui
Department of Neurology and Neuroscience Center, First Hospital of Jinlin University, No. 71, Xinmin Street, Changchun, 130021, Jilin, China.
Clin Drug Investig. 2016 Jul;36(7):509-17. doi: 10.1007/s40261-016-0396-9.
Vortioxetine and duloxetine are two new antidepressant drugs that have been used clinically in the treatment of major depressive disorder (MDD). The objectives of this meta-analysis were to evaluate the efficacy and tolerability of vortioxetine compared with duloxetine in MDD.
Randomized controlled trials (RCTs) published in PubMed, EMBASE, Web of Science, and ClinicalTrials.gov were systematically reviewed to compare vortioxetine with duloxetine in terms of efficacy and tolerability in patients with MDD. Results were expressed as the risk ratio (RR) with 95 % confidence intervals (CIs), and weighted mean difference (WMD). Pooled estimates were calculated by using a fixed-effects model or a randomized-effects model, depending on the heterogeneity among studies.
A total of five RCTs involving 2287 patients met the inclusion criteria and were included in this meta-analysis. Pooled results showed that duloxetine was associated with a higher response rate than vortioxetine, as well as showing a similar remission rate with vortioxetine. The changes from baseline in the Montgomery-Åsberg Depression Rating Scale (MADRS), 24-item Hamilton Rating Scale for Depression (HAM-D24), Clinical Global Impression-Improvement scale (CGI-I), CGI-Severity scale (CGI-S), Sheehan Disability Scale (SDS), and Hamilton Anxiety Rating Scale (HAM-A) scores were significantly greater in the duloxetine group than in the vortioxetine group. The incidence of treatment-emergent adverse events was significantly higher in the duloxetine group than in the vortioxetine group.
Duloxetine was more effective but less well-tolerated than vortioxetine in MDD. Considering the potential limitations of this meta-analysis, more large-scale RCTs are needed to confirm these findings.
伏硫西汀和度洛西汀是两种已在临床上用于治疗重度抑郁症（MDD）的新型抗抑郁药物。本荟萃分析的目的是评估伏硫西汀与度洛西汀治疗MDD的疗效和耐受性。
系统回顾了发表于PubMed、EMBASE、科学网和ClinicalTrials.gov上的随机对照试验（RCT），以比较伏硫西汀与度洛西汀治疗MDD患者的疗效和耐受性。结果以风险比（RR）及95%置信区间（CI）和加权均数差（WMD）表示。根据研究间的异质性，采用固定效应模型或随机效应模型计算合并估计值。
共有5项涉及2287例患者的RCT符合纳入标准并纳入本荟萃分析。合并结果显示，度洛西汀的缓解率高于伏硫西汀，且与伏硫西汀的缓解率相似。度洛西汀组蒙哥马利-Åsberg抑郁评定量表（MADRS）、24项汉密尔顿抑郁评定量表（HAM-D24）、临床总体印象改善量表（CGI-I）、临床总体印象严重程度量表（CGI-S）、希恩残疾量表（SDS）和汉密尔顿焦虑评定量表（HAM-A）评分较基线的变化显著大于伏硫西汀组。度洛西汀组治疗中出现的不良事件发生率显著高于伏硫西汀组。
在MDD治疗中，度洛西汀比伏硫西汀更有效，但耐受性较差。考虑到本荟萃分析的潜在局限性，需要更多大规模RCT来证实这些发现。
