Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
J Affect Disord. 2018 Mar 15;229:224-230. doi: 10.1016/j.jad.2017.12.103. Epub 2018 Jan 3.
The high heterogeneity was existed among the studies of the elderly participants with major depressive disorder (MDD), which may lead to incorrect conclusions in the previous meta-analysis. This study used model based meta-analysis to compare the efficacy of fluoxetine between the elderly and non-elderly participants with MDD and to explain the heterogeneity among the studies.
A comprehensive literature search was conducted in the public databases, involving utilization of fluoxetine for treating MDD in the acute-phase. The time-efficacy model was established based on the changes of the Hamilton Depression Rating Scale (HDRS) score compared to baseline level. The efficacy features and related factors of fluoxetine in the elderly participants were investigated by comparing with the non-elderly population.
Sixty-one studies encompassing 4058 participants were included in the analysis. We found the trial design of placebo controlled vs. comparator controlled was a significant impact factor for the efficacy of fluoxetine. The typical decrease rate of HDRS score in the elderly participants was strikingly lower than that of the non-elderly participants at week 8, with 39.9% vs. 49.1% in the placebo controlled trial and 46.5% vs. 57.2% in the comparator controlled trial.
The efficacy of other antidepressants except fluoxetine in the elderly participants need to be explored in the future study.
The efficacy of fluoxetine in the elderly participants was lower than that of the non-elderly participants. The heterogeneity of the trial design should be distinguished when comparing the efficacy of antidepressants between the elderly and non-elderly MDD participants.
老年重性抑郁障碍（MDD）患者的研究存在很大的异质性，这可能导致之前的荟萃分析得出错误的结论。本研究采用基于模型的荟萃分析比较氟西汀治疗老年和非老年 MDD 患者的疗效，并解释研究之间的异质性。
在公共数据库中进行了全面的文献检索，涉及氟西汀在急性期治疗 MDD 的应用。根据汉密尔顿抑郁量表（HDRS）评分与基线水平的变化建立时间疗效模型。通过与非老年人群比较，研究氟西汀在老年患者中的疗效特征和相关因素。
纳入分析的 61 项研究共包含 4058 名患者。我们发现，安慰剂对照与对照药物比较的试验设计是氟西汀疗效的一个显著影响因素。在第 8 周，安慰剂对照试验中氟西汀治疗后 HDRS 评分的典型下降率显著低于非老年组，为 39.9%比 49.1%；在对照药物比较试验中为 46.5%比 57.2%。
未来需要研究其他抗抑郁药（除氟西汀外）在老年患者中的疗效。
氟西汀在老年患者中的疗效低于非老年患者。在比较老年和非老年 MDD 患者抗抑郁药的疗效时，应区分试验设计的异质性。
