Furukawa Toshi A, Salanti Georgia, Atkinson Lauren Z, Leucht Stefan, Ruhe Henricus G, Turner Erick H, Chaimani Anna, Ogawa Yusuke, Takeshima Nozomi, Hayasaka Yu, Imai Hissei, Shinohara Kiyomi, Suganuma Aya, Watanabe Norio, Stockton Sarah, Geddes John R, Cipriani Andrea
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland Institute of Primary Health Care (BIHAM), University of Bern, Switzerland Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece.
BMJ Open. 2016 Jul 8;6(7):e010919. doi: 10.1136/bmjopen-2015-010919.
Many antidepressants are indicated for the treatment of major depression. Two network meta-analyses have provided the most comprehensive assessments to date, accounting for both direct and indirect comparisons; however, these reported conflicting interpretation of results. Here, we present a protocol for a systematic review and network meta-analysis aimed at updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression.
We will include all randomised controlled trials reported as double-blind and comparing one active drug with another or with placebo in the acute phase treatment of major depression in adults. We are interested in comparing the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will be the proportion of patients who responded to or dropped out of the allocated treatment. Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. To rank the various treatments for each outcome, we will use the surface under the cumulative ranking curve and the mean ranks. We will employ local as well as global methods to evaluate consistency. We will fit our model in a Bayesian framework using OpenBUGS, and produce results and various checks in Stata and R. We will also assess the quality of evidence contributing to network estimates of the main outcomes with the GRADE framework.
This review does not require ethical approval.
CRD42012002291.
许多抗抑郁药被用于治疗重度抑郁症。两项网状Meta分析提供了迄今为止最全面的评估，兼顾了直接和间接比较；然而，这些分析对结果的解释相互矛盾。在此，我们提出一项系统评价和网状Meta分析方案，旨在更新证据基础，并比较所有第二代以及选定的第一代抗抑郁药在急性治疗重度抑郁症时的疗效和可接受性。
我们将纳入所有报告为双盲的随机对照试验，这些试验在成人重度抑郁症急性期治疗中比较一种活性药物与另一种活性药物或与安慰剂。我们感兴趣比较的活性药物如下：阿戈美拉汀、阿米替林、安非他酮、西酞普兰、氯米帕明、去甲文拉法辛、度洛西汀、艾司西酞普兰、氟西汀、氟伏沙明、左旋米那普明、米那普明、米氮平、奈法唑酮、帕罗西汀、瑞波西汀、舍曲林、曲唑酮、文拉法辛、维拉唑酮和伏硫西汀。主要结局将是对分配治疗有反应或退出分配治疗的患者比例。将通过相关数据库检索、试验注册库和网站查找已发表和未发表的研究；所有参考文献筛选和数据提取将由至少两名独立评审员进行。我们将进行随机效应网状Meta分析，以综合每个结局的所有证据，并获得所有治疗的全面排名。为了对每个结局的各种治疗进行排名，我们将使用累积排名曲线下面积和平均排名。我们将采用局部和全局方法来评估一致性。我们将使用OpenBUGS在贝叶斯框架下拟合模型，并在Stata和R中生成结果及进行各种检验。我们还将使用GRADE框架评估对主要结局的网络估计有贡献的证据质量。
本评价无需伦理批准。
PROSPERO注册号：CRD42012002291。
