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Is it worth assessing progress as early as week 2 to adapt antidepressive treatment strategy? Results from a study on agomelatine and a global meta-analysis

Published online by Cambridge University Press:  15 April 2020

P. Gorwood ,
F. Bayle ,
G. Vaiva ,
P. Courtet ,
E. Corruble  and
P.-M. Llorca
P. Gorwood*
Affiliation:
Centre Hospitalier Sainte-Anne (CMME), 100, rue de la Santé, 75014Paris, France Inserm U894, University Paris-Descartes, Centre of Psychiatry and Neuroscience, 2ter, rue d'Alesia, 75014Paris, France
F. Bayle
Affiliation:
Inserm U894, University Paris-Descartes, Centre of Psychiatry and Neuroscience, 2ter, rue d'Alesia, 75014Paris, France Centre Hospitalier Sainte-Anne (SHU), 100, rue de la Santé, 75014Paris, France
G. Vaiva
Affiliation:
Pôle de psychiatrie, université Lille-Nord de France, CHRU de Lille, hôpital Michel-Fontan, 59037Lille cedex, France
P. Courtet
Affiliation:
Inserm U1061, CHRU de Montpellier, Montpellier, France
E. Corruble
Affiliation:
Inserm U669, Paris XI University, Psychiatry Department of Bicetre, University Hospital, AP—HP, 94275Le Kremlin Bicêtre, France
P.-M. Llorca
Affiliation:
CHU Clermont-Ferrand, BP 69, Clermont Université, université d'Auvergne, Clermont-Ferrand cedex 01, France
*
*Corresponding author. Tel.: +33 1 45 65 73 07; fax: +33 1 45 65 89 43. E-mail address:[email protected] (P. Gorwood).
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Abstract

Context:

A delay of 4–8 weeks before modifying the prescribed antidepressant treatment is usually proposed when incomplete treatment response is observed. A number of studies nevertheless proposed that the lack of early improvement (usually 20% decrease of severity at week 2) is predictive of the absence of subsequent treatment response, potentially saving weeks of inadequate treatment, but with no information for non-interventional studies devoted to outpatients.

Method:

Two thousand nine hundred and thirty-eight outpatients with major depressive disorder were included in a multicentre, non-interventional study, assessing at inclusion, week 2 and week 6, mood (QIDS-C, CGI, PGI and VAS) sleep (LSEQ) and functionality (SDS). All metrics at week 2 were tested for their capacity to predict response (and then remission) at week 6, all patients being treated by agomelatine. A meta-analysis of all studies (n = 12) assessing the predictive role of improvement at week 2 was also performed, assessing specific effect size of published studies and the weight of the different parameters they used.

Results:

The QIDS-C and the CGI-I were the only instruments with an area under the curve over 0.7, with different cut-offs for treatment response and remission. A decrease of more than five points at the QIDS-C had the highest positive predictive value for treatment response, and a CGI-I over three had the highest negative predictive value, which would favour relying on the clinicians for warning (too high CGI-I), and on instruments for confidence (favourable decrease of the QIDS-C). The meta-analysis of all studies also detected a large effect size of early improvement, stressing how rating week 2 severity could be beneficial in clinical practice.

Conclusions:

Previous reports stressing the interest of an assessment at week 2 were reinforced by the present results, which also defined more accurately what could be the most appropriate cut-offs, and how combining these early results could be more effective.

Keywords

Early responseTreatment responseMajor depressive disorderMarkerOutcome
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 6 , August 2013 , pp. 362 - 371
Copyright
Copyright © European Psychiatric Association

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