Is duloxetine more effective than other antidepressants as a continuation treatment following a 30% improvement in baseline (HAMD-17) symptoms of depression?

Quality assessmentSummary of findingsImportance
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsContinuation phase for those with 30% improvement in baseline HAMD-17 scores: duloxetineOther drugsRelative (95% CI)Absolute
Mean change scores from end of acute phase - 80 mg vs paroxetine (measured with: HAMD; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyserious1serious2none7070-MD 0.3 higher (1.06 lower to 1.66 higher)⊕⊕○○
LOW
Leaving treatment early - for any reason - paroxetine
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none58/71 (81.7%)61/70 (87.1%)RR 0.94 (0.81 to 1.08)5 fewer per 100 (from 17 fewer to 7 more)⊕⊕○○
LOW
Leaving treatment early - adverse reactions - paroxetine
2randomised trialsno serious limitationsno serious inconsistencyserious2very serious3none7/146 (4.8%)2/140 (1.4%)RR 2.84 (0.7 to 11.6)3 more per 100 (from 0 fewer to 15 more)⊕○○○
VERY LOW
Leaving treatment early - lack of efficacy - paroxetine
1randomised trialsno serious limitationsno serious inconsistencyserious2very serious4none1/71 (1.4%)2/70 (2.9%)RR 0.49 (0.05 to 5.31)1 fewer per 100 (from 3 fewer to 12 more)⊕○○○
VERY LOW
1

Single study

2

Selective outpatients from multiple sites

3

Inconsistent effect size

4

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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