- 作者：Richard A. Hansen ; Ph.D.a ; rah0019@auburn.edu ; Stacie B. Dusetzina ; Ph.D.b ; Alan R. Ellis ; M.S.W.c ; Til Stü ; rmer ; M.D. ; M.P.H.d ; Joel F. Farley ; Ph.D.e ; Bradley N. Gaynes ; M.D. ; M.P.H.f
- 关键词：Major depression ; Augment ; Switch ; Propensity score ; Adverse events
- 刊名：General Hospital Psychiatry
- 出版年：2012
- 期刊代码：107_01638343
- 类别：med
- 出版时间：March-April, 2012
- 卷：34
- 期：2
- 页码：192-200
- 文件大小：357 K
Objective
The objective was to assess differences in adverse events between major depressive patients augmented with a second medication and patients switched to an alternative monotherapy after failing first-step treatment with citalopram.Method
Adverse event profiles for second-step switch and augment medication strategies were compared using public data files from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. In the STAR*D trial, participants failing citalopram selected acceptable next-step strategies and were randomized within acceptable strategies. This design resulted in clinically important differences when comparing across strategies, so a propensity-score-matched sample was created to compare switch (n=269) and augment (n=269) strategies.
Results
Incidence proportions of any adverse event and specific adverse events were similar between the augment and switch groups. The overall incidence proportion of any distressing event was 0.78 [95%confidence interval (CI) 0.72-0.84] in the augment group and 0.80 (95%CI 0.74-0.85) in the switch group. This contrasts unmatched analyses where distressing adverse events were less common in the augment group than the switch group (risk ratio 0.85, 95%CI 0.81-0.90).
Conclusion
After adjusting for selection bias inherent in the STAR*D comparison of augment with switch, clinically meaningful differences in the adverse event profiles between these treatment strategies were not observed.