Efficacy and Acceptability of Pharmacological Treatments for Post- Stroke Depression: A Bayesian Network Meta-Analysis

Transcription

1 Efficacy and Acceptability of Pharmacological Treatments for Post- Stroke Depression: A Bayesian Network Meta-Analysis Presenter: Miss Deng Tutor: Prof. Liu Ming Department of Neurology West China Hospital of Sichuan University Chengdu, China

2 Four parts Background and aims Method Results Conclusions

3 Background and aims Post-stroke depression (PSD) 31% Poorer recovery/ Higher mortality rates Pharmacological therapy SSRIs, (fluoxetine, citalopram, sertraline, paroxetine, ) TCAs, (nortriptyline, imipramine, ) NRIs, (reboxetine, ) SNRIs, (duloxetine, venlafaxine, ) TCM (Chinese traditional medicine)

4 Background and aims Although SSRIs are gaining popular as first-line treatment for PSD and late-life depression, there is no study providing conclusive evidence on the superiority of any particular SSRI over any other drugs. Aim to compare all available interventions using both direct and indirect data.

5 Method Studies(using Hamiton Depression Scale [HAM-D]) Comparison and outcomes I. Primary outcome: mean change in HAMD score substance class (SSRIs/TCAs/NRIs ) according to their endpoints in the original trials. single drug(as subgroup analysis) according to the original endpoints in the trials; 4-week endpoint (as the short-term efficacy); 8-week endpoint (as the medium-term efficacy). II. Secondary outcome: response rate and acceptability according to the drop-out rate.

6 Results: Figure 1 : PRISMA flow diagram

7 Figure 2: Network diagram of eligible comparisons for reduction of HAMD score between individual substance class. (Five substance classes were included. ) The width of each line is proportional to the number of trials comparing every pair of treatments. (Chinese traditional medicine) The size of each circle is proportional to the number of sample size.

8 Figure 3: Network meta-analysis of efficacy of individual substance class.(reduction in HAMD score) Significant results are circled.

9 Figure 4: Summary odds ratio and credible intervals of response rate of individual substance class. There is no significant result.

10 Figure 5: Network diagram of eligible comparisons for reduction of HAMD score between individual pharmacotherapy (14 drugs were included) (A kind of traditional Chinese medicine)

11 Figure 6: Network diagram of eligible comparisons for reduction of HAMD score between individual pharmacotherapy original endpoint. Significant results are circled.

12 Figure 7: Summary odds ratio and credible intervals of response rate of individual drug. In terms of response rate, nortriptyline ranked the best. It is more effective when compared with clomipramine, fluoxetine and placebo.

13 Figure 8: Network diagram of eligible comparisons for reduction of HAMD score between individual pharmacotherapy 4-week endpoint (short-term efficacy). Significant results are circled (in red). Duloxetine ranked the best. Duloxetine is more effective in HAMD reduction when compared with sertraline or citalopram.

14 For medium-term efficacy (8-week endpoint), Duloxetine ranked the best again. Duloxetine, reboxetine, nortriptyline, citalopram and fluoxetine were proved to be more effective than placebo. There is no significant difference among the drugs. For acceptability, there is no significant difference among all the drugs and placebo.

15 Conclusions NRI, TCAs and SSRIs are associated with significantly better HAMD score reduction compared with control. Nortriptyline is a better approach for managing PSD compared with fluoxetine, clomipramine and placebo in terms of response rate. In terms of short-term efficacy, duloxetine is more effective in HAMD reduction when compared with sertraline or citalopram. In terms of acceptability, there is no significant difference among all the drugs and placebo. Our findings can represent an important evidence-based counseling material, but should critically interpreted within the constraints and limitations of this type of pooled analysis.

16 Thanks for listening! If you have any questions or if you are interested in PSD management, please do not hesitate to contact with me: Looking forward to hearing from you!