Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons

Eckert, Laurent; Lançon, Christophe
January 2006
BMC Psychiatry;2006, Vol. 6, p30
Academic Journal
Background: Data comparing duloxetine with existing antidepressant treatments is limited. A comparison of duloxetine with fluoxetine has been performed but no comparison with venlafaxine, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken. In the absence of relevant data to assess the place that duloxetine should occupy in the therapeutic arsenal, indirect comparisons are the most rigorous way to go. We conducted a systematic review of the efficacy of duloxetine, fluoxetine and venlafaxine versus placebo in the treatment of Major Depressive Disorder (MDD), and performed indirect comparisons through meta-regressions. Methods: The bibliography of the Agency for Health Care Policy and Research and the CENTRAL, Medline, and Embase databases were interrogated using advanced search strategies based on a combination of text and index terms. The search focused on randomized placebo-controlled clinical trials involving adult patients treated for acute phase Major Depressive Disorder. All outcomes were derived to take account for varying placebo responses throughout studies. Primary outcome was treatment efficacy as measured by Hedge's g effect size. Secondary outcomes were response and dropout rates as measured by log odds ratios. Meta-regressions were run to indirectly compare the drugs. Sensitivity analysis, assessing the influence of individual studies over the results, and the influence of patients' characteristics were run. Results: 22 studies involving fluoxetine, 9 involving duloxetine and 8 involving venlafaxine were selected. Using indirect comparison methodology, estimated effect sizes for efficacy compared with duloxetine were 0.11 [-0.14;0.36] for fluoxetine and 0.22 [0.06;0.38] for venlafaxine. Response log odds ratios were -0.21 [-0.44;0.03], 0.70 [0.26;1.14]. Dropout log odds ratios were -0.02 [-0.33;0.29], 0.21 [-0.13;0.55]. Sensitivity analyses showed that results were consistent. Conclusion: Fluoxetine was not statistically different in either tolerability or efficacy when compared with duloxetine. Venlafaxine was significantly superior to duloxetine in all analyses except dropout rate. In the absence of relevant data from head-to-head comparison trials, results suggest that venlafaxine is superior compared with duloxetine and that duloxetine does not differentiate from fluoxetine.


Related Articles

  • Cost-effectiveness of outpatient treatment in depressive patients with escitalopram in Germany. Kulp, Werner; Graf von de Schulenburg, J.-M.; Greiner, Wolfgang // European Journal of Health Economics;Dec2005, Vol. 6 Issue 4, p317 

    We investigated the cost-effectiveness of escitalopram (10 mg daily dose) vs. venlafaxine XR (75 mg daily dose) in a German outpatient setting for the treatment of unipolar depression (MADRS score 20–34) over a period of 70 days. To assess the cost effectiveness of the two substances we...

  • Remission from depression : a review of venlafaxine clinical and economic evidence. Han, Donald; Wang, Edward C.Y. // PharmacoEconomics;2005, Vol. 23 Issue 6, p567 

    Worldwide, major depression is the leading cause of years lived with a disability, and the fourth cause of disability-adjusted life years. Depression is second only to hypertension as the most common chronic condition encountered in general medical practice. Unfortunately, despite the high...

  • Venlafaxine Effectively Treats Generalized Anxiety Disorder. Miller, Karl E. // American Family Physician;12/15/2000, Vol. 62 Issue 12, p2682 

    Presents a study by K. Rickels and others on the safety and efficacy of extended-release venlafaxine in the treatment of generalized anxiety disorder without concomitant major depressive disorder. Description of the study and its results; Conclusion that extended-release venlafaxine is a safe...

  • Fluoxetine/paroxetine/venlafaxine.  // Reactions Weekly;Jul2015, Vol. 1558 Issue 1, p89 

    The article presents case reports of 12 patients who experienced syndrome of pathological alcohol intoxication while taking fluoxetine, paroxetine or venlafaxine and consuming alcohol. In one case, a patient, who was receiving paroxetine, became uncharacteristically verbally and physically...

  • Cost-effectiveness of venlafaxine XL compared with diazepam in the treatment of generalised anxiety disorder in the United Kingdom. Guest, J.; Russ, J.; Lenox-Smith, A.; Guest, J F // European Journal of Health Economics;Jun2005, Vol. 6 Issue 2, p136 

    This study used decision modelling to compare the cost-effectiveness of venlafaxine XL (Efexor XL) to that of diazepam to treat non-depressed patients suffering from generalised anxiety disorder (GAD), from the perspective of the United Kingdom's National Health Service (NHS). Starting treatment...

  • Effect of venlafaxine on maximal electroshock induced seizures in mice. Aricioglu, Feyza; Salanturoglu, Gamze; Buldanlioglu, Ulas; Ozyalcin, Suleyman // Annals of General Psychiatry;2006 Supplement 1, Vol. 5, pS103 

    A conference paper on the effect of venlafaxine, an antidepressant that inhibits reuptake of both serotonin and norepinephrine, on maximal electroshock (MES) induced seizures in mice is presented. Results reveals a clinical importance of selecting an antidepressant in epileptic patients....

  • 'Why has your GP put you on that rubbish? You're not depressed are you?'. Hope, Sally // Journal of the British Menopause Society;2001, Vol. 7 Issue 3, p138 

    The article presents cancer patients and survivors and their therapeutics. Breast cancer survivors were revealed to benefit from venlafaxine, the same with men with prostate cancer undergoing androgen-deprivation therapy. Hot flushes were also reduced with the use of paroxetine. Three specific...

  • The influence of tobacco smoke and nicotine on antidepressant and memory-improving effects of venlafaxine. Nowakowska, Elżbieta; Kus, Krzysztof; Florek, Ewa; Czubak, Anna; Jodynis-Liebert, Jadwiga // Human & Experimental Toxicology;Apr2006, Vol. 25 Issue 4, p199 

    In experimental and clinical studies, central nicotinic systems have been shown to play an important role in cognitive function. Nicotinic acetylcholine receptors also mediate the reinforcing properties of nicotine (NIC) in tobacco products. A variety of studies have shown that acute treatment...

  • Just SAY NO TO DRUGS. Simmons, Nora // Natural Solutions;Mar2009, Issue 115, p16 

    The article offers information on the effectiveness of acupuncture in treating hot flashes. It notes that a new study presented at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston, Massachusetts found out that acupuncture reduced hot flashes as...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics