Department of Medicine, Evangelical University of Goiás, Anápolis, Brazil.
Department of Medicine, Catholic University of Pernambuco, Recife, Brazil.
Asian J Psychiatr. 2024 Nov;101:104222. doi: 10.1016/j.ajp.2024.104222. Epub 2024 Sep 6.
Although vortioxetine demonstrates superior efficacy relative to placebo, there is still a lack of robust evidence to determine whether it offers advantages over commonly prescribed antidepressants for treating major depressive disorder (MDD). Thus, we aimed to perform a systematic review and meta-analysis comparing vortioxetine vs reuptake inhibitors in adults with MDD, analyzing two classes separately: (i) vortioxetine vs SSRIs and (ii) vortioxetine vs SNRIs.
We searched MEDLINE, Embase, and Cochrane Library databases for randomized controlled trials comparing vortioxetine with SSRIs or SNRIs in adults with a primary diagnosis of MDD following standardized diagnostic criteria. Independent examiners conducted the literature search, study selection, data extraction, and risk of bias assessment. Data were pooled in random-effects analyses. Statistical significance was considered at p<0.05.
We included 6 trials (n=478) in the vortioxetine vs SSRIs analysis and 11 (n=4230) in the vortioxetine vs SNRIs analysis. There were no significant differences between vortioxetine and SSRIs/SNRIs in the probability of response, remission, overall dropouts, and dropout due to lack of efficacy. Vortioxetine provided a significantly lower risk of dropout due to adverse events compared with SNRIs, while not significant compared with SSRIs. Vortioxetine did not differ significantly from SNRIs regarding variation in MADRS score post-treatment. In general, vortioxetine exhibited a statistically lower risk of individual adverse events compared with SNRIs, while not significant compared with SSRIs.
Our study reveals that vortioxetine is as effective as SSRIs and SNRIs for treating MDD, with safety equivalent to SSRIs and superior to SNRIs.
尽管文拉法辛在疗效上优于安慰剂，但仍缺乏有力的证据来确定其在治疗重度抑郁症（MDD）方面是否优于常用的抗抑郁药。因此，我们旨在进行一项系统评价和荟萃分析，比较文拉法辛与抗抑郁药治疗 MDD 成人患者的疗效，分别分析两类药物：（i）文拉法辛与 SSRI 类药物，（ii）文拉法辛与 SNRIs 类药物。
我们检索了 MEDLINE、Embase 和 Cochrane 图书馆数据库，以寻找比较文拉法辛与 SSRI 或 SNRIs 治疗符合标准化诊断标准的 MDD 成人患者的随机对照试验。独立评估员进行了文献检索、研究选择、数据提取和偏倚风险评估。数据采用随机效应分析进行汇总。统计显著性水平设为 p<0.05。
我们将 6 项试验（n=478）纳入文拉法辛与 SSRI 类药物的分析，11 项试验（n=4230）纳入文拉法辛与 SNRIs 类药物的分析。文拉法辛与 SSRI/SNRI 类药物在应答率、缓解率、总体脱落率和因疗效不佳而脱落率方面无显著差异。与 SNRIs 类药物相比，文拉法辛降低因不良反应而脱落的风险显著更低，而与 SSRI 类药物相比则无显著差异。文拉法辛与 SNRIs 类药物在治疗后 MADRS 评分变化方面无显著差异。总体而言，文拉法辛与 SNRIs 类药物相比，个别不良反应的风险显著降低，而与 SSRI 类药物相比则无显著差异。
我们的研究表明，文拉法辛治疗 MDD 的疗效与 SSRI 和 SNRIs 类药物相当，安全性与 SSRI 类药物相当，优于 SNRIs 类药物。
