Early Improvement in Depressive Symptoms With Desvenlafaxine 50 mg/d as a Predictor of Treatment Success in Patients With Major Depressive Disorder

Soares, Cláudio N.; Fayyad, Rana; Guico-Pabia, Christine J.

doi:10.1097/jcp.0000000000000049

Cited by 21 publications

(24 citation statements)

References 34 publications

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“…Symptomatic improvement during the first few weeks of treatment has been shown to predict later response or remission with some antidepressants (Szegedi et al, 2003(Szegedi et al, , 2009Kok et al, 2009;Soares et al, 2014) and may also be predictive of improvements in functioning. However, few randomized controlled trials have evaluated the effects of antidepressant treatment on functional outcomes in patients with MDD (Kocsis et al, 2002;Szegedi et al, 2003;Trivedi et al, 2010;Dunlop et al, 2011;Oakes et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Predictors of functional improvement in employed adults with major depressive disorder treated with desvenlafaxine

Lam

Endicott²,

Hsu³

et al. 2014

International Clinical Psychopharmacology

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We carried out a secondary analysis of a double-blind, placebo-controlled trial of desvenlafaxine for major depressive disorder (MDD) to explore the associations between depressive symptoms and subtypes, and functional outcomes, including work functioning. Employed outpatients with MDD were assigned randomly in a 2 : 1 ratio to receive desvenlafaxine 50 mg/day or placebo for 12 weeks. Analyses were carried out post-hoc with the intent-to-treat (ITT) sample (N=427) and a prospectively defined modified ITT sample (N=310), composed of patients with baseline 17-item Hamilton Rating Scale for Depression score of at least 20. Functional outcomes at week 12 included items and factors from the Montgomery-Åsberg Depression Rating Scale, Sheehan Disability Scale, and the Work Productivity and Activity Impairment questionnaire. In the modified ITT sample, but not in the ITT sample, desvenlafaxine-treated patients showed significantly greater improvement in several functional outcomes in the responder, nonanxious, and normal-energy patient subgroups. Improvement in the 17-item Hamilton Rating Scale for Depression total score at week 2 predicted change at week 12 in several functional outcomes. Functional improvement at 12 weeks was greater in subgroups of patients and was also significantly predicted by early improvement in depressive symptoms in employed patients with MDD treated with desvenlafaxine.

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Section: Introductionmentioning

confidence: 99%

Predictors of functional improvement in employed adults with major depressive disorder treated with desvenlafaxine

Lam

Endicott²,

Hsu³

et al. 2014

International Clinical Psychopharmacology

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“…Early improvement was usually defined as at least 20 % reduction in HAM-D or MADRS (n = 11 studies). Two studies also examined optimum definitions of early improvement using receiver operating characteristic analysis [16,17]. For early improvement at 2 weeks, PPVs were 26-84 %, while NPVs were 35-92 %.…”

Section: Predictive Value Of Early Improvementmentioning

confidence: 99%

Early Switching Strategies in Antidepressant Non-Responders: Current Evidence and Future Research Directions

2014

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Studies have found that up to two-thirds of patients with major depressive disorder (MDD) do not fully respond to the first antidepressant. While switching antidepressants is a common strategy for antidepressant nonresponders, there is still a lack of consensus about the optimal timing of a switch. Many clinicians wait for 6-12 weeks before considering a switch. The objectives of this paper are to (1) review the evidence for positive and negative predictive value (NPV) of early improvement at 2-4 weeks to predict final antidepressant response; (2) review randomized controlled trials (RCTs) that examine early switching strategies; and (3) provide future research directions and clinical recommendations for timing of antidepressant switching. We conducted a literature search for English

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“…[18][19][20][21][22][23][24] A series of analyses have been conducted to examine the predictive value of early improvement of depressive symptoms on other treatment outcomes using data from placebo-controlled trials of desvenlafaxine for the treatment of MDD. 17,25,26 In addition to confirming an effect of early symptom improvement on the probability of achieving response and remission from depression, 17 analyses have demonstrated that early depressive symptom improvement could also predict later functional outcomes in MDD patients treated with desvenlafaxine 50 mg or placebo. 25,26 Week-2 improvements (depressive symptoms in one study 26 and functional improvement in a pooled analysis 25 ) were significant predictors of functional outcomes (Sheehan Disability Scale 27 [SDS] score, functional response, or functional remission) at study end (week 8 or week 12).…”

Section: Introductionmentioning

confidence: 95%

“…16 Results of analyses show that improvement in depression symptoms within 2-4 weeks of starting an antidepressant predicts response and remission 7 and, importantly, that failure to show early improvement predicts poor treatment outcomes. 17 The predictive value of lack of early improvement (i.e., negative predictive value (NPV)) has been demonstrated across antidepressant drug classes in patients treated with tricyclic antidepressants, selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, and new-generation antidepressants. 7 Thus, adjustments to medication regimen, starting with dose optimization, should be considered as early as 2 weeks after initiation of treatment.…”

Section: Introductionmentioning

confidence: 99%

Predictors of functional response and remission with desvenlafaxine 50 mg and 100 mg: a pooled analysis of randomized, placebo-controlled studies in patients with major depressive disorder

2019

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Objective.The value of early functional improvement at week 2 for predicting subsequent functional outcomes at week 8 was assessed in a pooled analysis of patients with major depressive disorder (MDD) treated with desvenlafaxine (50 or 100 mg/d) or placebo.Methods.Data were pooled from eight double-blind, placebo-controlled studies of desvenlafaxine 50 mg/d or 100 mg/d for the treatment of MDD. Optimal week-2 improvement thresholds in Sheehan Disability Scale (SDS) score, which best predicted week-8 treatment success, were determined using receiver operating characteristic (ROC) analysis. Four definitions of treatment success were established: (1) functional response, (2) functional/depression response, (3) functional remission, and (4) functional/depression remission. Odds ratios (ORs) of early improvement for prediction (based on thresholds determined in the ROC analysis) of week-8 treatment success were computed using logistic regression models.Results.Functional early improvement thresholds of 17%–32% were predictive of week-8 treatment success across treatment groups and definitions of treatment success. Optimal thresholds were higher for more stringent definitions. Negative predictive value exceeded positive predictive value, indicating that failure to achieve early functional improvement was more informative about later treatment success than was the achievement of early functional improvement. Early change in SDS was a highly significant predictor of functional response/remission (ORs, 4.981–8.737; all p < 0.0001); the interaction between treatment and early functional improvement was not significant.Conclusion.Early improvement in SDS total score was predictive of functional outcomes for patients treated with desvenlafaxine 50 mg, desvenlafaxine 100 mg, or placebo.

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Early Improvement in Depressive Symptoms With Desvenlafaxine 50 mg/d as a Predictor of Treatment Success in Patients With Major Depressive Disorder

Abstract: Clinical observations of patients' early response to desvenlafaxine 50 mg/d may have clinical value in predicting treatment success and guiding patient management.

Cited by 21 publications

References 34 publications

Predictors of functional improvement in employed adults with major depressive disorder treated with desvenlafaxine

Predictors of functional improvement in employed adults with major depressive disorder treated with desvenlafaxine

Early Switching Strategies in Antidepressant Non-Responders: Current Evidence and Future Research Directions

Predictors of functional response and remission with desvenlafaxine 50 mg and 100 mg: a pooled analysis of randomized, placebo-controlled studies in patients with major depressive disorder

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