Is duloxetine more effective than other antidepressants following response to acute phase treatment?

Quality assessmentSummary of findingsImportance
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsContinuation phase no entry criteria: duloxetineOther drugsRelative (95% CI)Absolute
Mean scores at endpoint - escitalopram (measured with: HAMD; Better indicated by lower values)
1randomised trialsno serious limitationsno seriousserious1serious2none146141-MD 1.34 higher (0.25 lower to 2.93 higher)⊕⊕○○
LOW
Non-response - escitalopram
1randomised trialsno serious limitationsno serious inconsistencyserious1very serious3none49/151 (32.5%)40/143 (28%)RR 1.16 (0.82 to 1.65)4 more per 100 (from 5 fewer to 18 more)⊕○○○
VERY LOW
Non-remission - escitalopram
1randomised trialsno serious limitationsno serious inconsistencyserious1serious2none39/151 (25.8%)28/143 (19.6%)RR 1.32 (0.86 to 2.02)6 more per 100 (from 3 fewer to 20 more)⊕⊕○○
LOW
Leaving treatment early - any reason - escitalopram
1randomised trialsno serious limitationsno serious inconsistencyserious1very serious3none37/151 (24.5%)31/143 (21.7%)RR 1.13 (0.74 to 1.72)3 more per 100 (from 6 fewer to 16 more)⊕○○○
VERY LOW
Leaving treatment early - adverse reactions - escitalopram
1randomised trialsno serious limitationsno serious inconsistencyserious1serious2none26/151 (17.2%)13/143 (9.1%)RR 1.89 (1.01 to 3.54)8 more per 100 (from 0 more to 23 more)⊕⊕○○
LOW
Leaving treatment early - lack of efficacy - escitalopram
1randomised trialsno serious limitationsno serious inconsistencyserious1very serious3none2/151 (1.3%)7/143 (4.9%)RR 0.27 (0.06 to 1.28)4 fewer per 100 (from 5 fewer to 1 more)⊕○○○
VERY LOW
1

Selected patients from multiple sites

2

Single study

3

Single study + inconsistent effect size

Selected patients from multiple sites

Single study

Single study + inconsistent effect size

From: APPENDIX 16, CLINICAL EVIDENCE PROFILES

Cover of Depression
Depression: The Treatment and Management of Depression in Adults (Updated Edition).
NICE Clinical Guidelines, No. 90.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2010.
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

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