Trial reportClinical drug investigation2012
Early non-response in patients with severe depression: escitalopram up-titration versus switch to duloxetine.
Trial report in Clinical drug investigation, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00384436 (Fixed Dose Comparison of Escitalopram to an Active Comparator in Severely Depressed Patients), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Fixed Dose Comparison of Escitalopram to an Active Comparator in Severely Depressed Patients
Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Pharmacological interventions for treatment-resistant depression in adults.The Cochrane database of systematic reviews · 2019Pooled it
- Effect of antidepressant switching between nortriptyline and escitalopram after a failed first antidepressant treatment among patients with major depressive disorder.The British journal of psychiatry : the journal of mental science · 2019Trial
- Efficacy and safety of escitalopram in treatment of severe depression in Chinese population.Metabolic brain disease · 2017Trial
- Predictors of Cognitive Improvement during 12 Weeks of Antidepressant Treatment in Patients with Major Depressive Disorder.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2018Article
- Role of AMPA receptors in homocysteine-NMDA receptor-induced crosstalk between ERK and p38 MAPK.Journal of neurochemistry · 2017Article
- Early switching strategies in antidepressant non-responders: current evidence and future research directions.CNS drugs · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComparative evidence for second-step treatment strategies in severe depression is scarce. Up-titrating a well tolerated selective serotonin reuptake inhibitor (SSRI) versus switching to a serotonin norepinephrine reuptake inhibitor (SNRI) after initial SSRI non-response are possible treatment options. It is often unclear whether relevant tolerability and efficacy differences exist between SSRI up-titration versus switch to an SNRI.
objectiveThe objective of this study was to evaluate tolerability and efficacy of up-titration of escitalopram versus switch to duloxetine in patients who failed to respond to escitalopram 10 mg/day.
methodsThis was an active-controlled, parallel-group, double-blind, randomized study in a general community comparing escitalopram and duloxetine in patients with severe depression; patients who did not respond (<50% Montgomery-Åsberg Depression Rating Scale [MADRS] improvement) to 2 weeks of single-blind escitalopram 10 mg/day during the lead-in period were randomized to 8 weeks of double-blind treatment. 571 male and female outpatients aged 18-65 years with severe depression (MADRS total score ≥30) participated in the study and received at least one dose of escitalopram 10 mg/day in the single-blind lead-in phase. During the double-blind randomized phase, 474 patients who did not respond to lead-in escitalopram were randomized and received treatment with escitalopram 20 mg (n = 229) or duloxetine 60 mg (n = 245). Treatment was single-blind escitalopram 10 mg/day during a 2-week lead-in followed by 8-week double-blind escitalopram 20 mg/day or duloxetine 60 mg/day. The main outcome measure was time to all-cause premature study discontinuation.
resultsThere was no difference in time to all-cause discontinuation between groups (hazard ratio escitalopram/duloxetine = 0.95 [95% CI 0.64, 1.41]; p = 0.727). Treatment with escitalopram compared with duloxetine resulted in significant improvement in MADRS total score at the end of week 8 (least squares mean difference [LSMD] = -1.87 [95% CI -3.60, -0.14]; p = 0.034) using last observation carried forward (LOCF) analysis. Significantly more escitalopram (54%) than duloxetine (42%) patients achieved remission (MADRS ≤10) by week 8 (p = 0.013). Adverse events were similar between the two treatment groups.
conclusionIn initial non-responders to escitalopram 10 mg/day, dose escalation to 20 mg/day provided better efficacy than switching to duloxetine 60 mg/day, while discontinuations for any reasons and adverse events were similar. CLINICAL
trial registrationRegistered at ClinicalTrials.gov as NCT00384436.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.