Early Symptom Improvement as a Predictor of Response to Extended Release Quetiapine in Major Depressive Disorder.

Abstract

The aim of this post-hoc analysis was to determine whether early symptom improvement with extended release quetiapine (quetiapine XR) may predict treatment outcome in patients with major depressive disorder. Data were from 6, double-blind, placebo-controlled studies of quetiapine XR (2 fixed-dose and 2 flexible-dose monotherapy and 2 adjunct studies) in adult patients with major depressive disorder. Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression-Severity Score (CGI-S) were assessed at baseline, weeks 2, 4, and 6. Hamilton Rating Scale for Depression (HAM-D) was assessed at baseline and week 6. The MADRS improvement at week 2 (15%, 20%, 25%, 30%) was used to predict response and remission, based on MADRS (50% improvement; total score ≤ 12) or HAM-D (50% improvement; total score ≤ 7). The CGI-S improvement (1 point) at week 2 was used to predict final outcome (CGI-S score ≤ 2). The predictive value for early improvement with quetiapine XR was found to be "very strong" (Yule's Q coefficient, a combined measure of sensitivity and specificity) using 30% MADRS improvement as the threshold. This was relatively comparable for response and remission and for fixed-dose, flexible-dose, and adjunct studies. This was also observed for placebo. Exceptions were: adjunct studies (where predictivity was lower for ongoing antidepressant/placebo), and for remission (predictivity for remission appeared lower than for response with placebo). In conclusion, outcome at week 6 with quetiapine XR for a major depressive episode could be predicted by 30% improvement after 2 weeks, a finding that could give doctors confidence to continue treatment and may facilitate adherence in patients.

• Authors: Roger S McIntyre, Philip Gorwood, Michael E Thase, Charlie Liss, Dhaval Desai, Ji Chen, Michael Bauer
• Journal: Journal of clinical psychopharmacology (J Clin Psychopharmacol) Vol. 35 Issue 6 Pg. 706-10 (Dec 2015) ISSN: 1533-712X [Electronic] United States
• PMID: 26474010 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Antipsychotic Agents
• Delayed-Action Preparations
• Quetiapine Fumarate

Topics

• Adult
• Antipsychotic Agents (administration & dosage, pharmacology)
• Delayed-Action Preparations
• Depressive Disorder, Major (drug therapy)
• Humans
• Multicenter Studies as Topic (statistics & numerical data)
• Outcome Assessment, Health Care
• Quetiapine Fumarate (administration & dosage, pharmacology)
• Randomized Controlled Trials as Topic (statistics & numerical data)