Efficacy and Safety of Duloxetine versus Paroxetine for Adults’ Depression: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Cheng ¹ ,  XU Weiping ¹ , HUANG Ying ¹ , XU Tingjuan ¹ , WEI Wei ² , HU Shilian ¹ , YAN Guang ¹

1. Anhui Medical University Provincial Hospital, Hefei 230001, China;2. Institute of Clinical Pharmacology of Anhui Medical University, Hefei 230032, China;

Corresponding author：

XU Weiping, Email: xwp5606@163.com

Keywords：

Duloxetine; Paroxetine; Depression; Meta-analysis; Systematic review; Randomized controlled tiral

DOI：

10.7507/1672-2531.20120052

Video：

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Objective　 To systematically evaluate the efficacy and safety of duloxetine versus paroxetine for adults’ depression.
Methods　 A search was conducted in The Cochrane Library (Issue 6, 2011), Pubmed (1998 to June 2011), CNKI (1998 to June 2011), VIP (1998 to June 2011), CBM (1998 to June 2011), Wanfang database (1998 to June 2011), MEDLINE (1996 to June 2011) and Science Direct (1998 to June 2011). The randomized controlled trials (RCTs) on duloxetine versus paroxetine for adults’ depression were collected. The quality of the included trials was assessed according to the Cochrane Handbook 5.0, and the systematic analysis was conducted by using RevMan 5.0 software.
Results　 Six RCTs involving 1 106 patients were included. The results of meta-analysis showed that: a) After eight-week treatment, there were no significant differences in the effective rate (RR=0.96, 95%CI 0.89 to 1.05, P=0.39) and the final cure rate (RR=0.99, 95%CI 0.86 to 1.15, P=0.93) between the duloxetine and paroxetine groups; b) Adverse reaction: The incidence rate of somnolence in the duloxetine group was lower than that of the paroxetine group (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), oppositely, the incidence rate of abnormal ECG was higher in the duloxetine group (RR=1.91, 95%CI, 1.02 to 3.58, P=0.04). And the other common adverse reactions were not significantly different between the two groups (P gt;0.05).
Conclusion　 After eight-week treatment, there are no significant differences in the effective rate and the final cure rate between duloxetine and paroxetine. Duloxetine tends easily to induce the abnormal ECG compared with paroxetine.

Citation： CHEN Cheng,XU Weiping,HUANG Ying,XU Tingjuan,WEI Wei,HU Shilian,YAN Guang. Efficacy and Safety of Duloxetine versus Paroxetine for Adults’ Depression: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(3): 320-325. doi: 10.7507/1672-2531.20120052 Copy

1.	Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry, 2001, 62 Suppl 16: 26-31.
2.	Perahia DG, Quail D, Desaiah D, et al. Switching to duloxetine in selective serotonin reuptake inhibitor non- and partial-responders: effects on painful physical symptoms of depression. J Psychiatr Res, 2009, 43(5): 512-518.
3.	Knadler MP, Lobo E, Chappell J, et al. Duloxetine: clinical pharmacokinetics and drug interactions. Clin Pharmacokinet, 2011, 50(5): 281-294.
4.	Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet, 2009, 373(9665): 746-758.
5.	Cremers TI, Rea K, Bosker FJ, et al. Augmentation of SSRI effects on serotonin by 5-HT2C antagonists: mechanistic studies. Neuropsychopharmacology, 2007, 32(7): 1550-1557.
6.	Gueorguieva R, Mallinckrodt C, Krystal JH. Trajectories of depression severity in clinical trials of duloxetine: insights into antidepressant and placebo responses. Arch Gen Psychiatry, 2011, 68(12): 1227-1237.
7.	Maier W, Philipp M. Improving the assessment of severity of depressive states: a reduction of the Hamilton Depression Scale. Pharmacopsychiatry, 1985, 18: 114-115.
8.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
9.	Detke MJ, Wiltse CG, Mallinckrodt CH, et al. Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Neuropsychopharmacol, 2004, 14(6): 457-470.
10.	Perahia DG, Wang F, Mallinckrodt CH, et al. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry, 2006, 21(6): 367-378.
11.	Lee P, Shu L, Xu X, et al. Once-daily duloxetine 60 mg in the treatment of major depressive disorder: multicenter, double-blind, randomized, paroxetine-controlled, non-inferiority trial in China, Korea, Taiwan and Brazil. Psychiatry Clin Neurosci, 2007, 61(3): 295-307.
12.	邱堂威, 彭德华, 刘敏. 度洛西汀与帕罗西汀治疗抑郁症对照分析. 中国民康医学, 2008, 20(23): 2772-2774.
13.	李雪汉. 盐酸度洛西汀治疗抑郁症的临床疗效和安全性. 河北医科大学学报, 2011, 32(2): 199-201.
14.	张雄, 马世发, 李亚军. 度洛西汀与帕罗西汀治疗抑郁症对照观察. 中外医学研究, 2011, 9(1): 16-17.
15.	Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology, 2001, 25(6): 871-880.
16.	Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs, 2009, 23(6): 523-541.
17.	Wohlreich MM, Mallinckrodt CH, Prakash A, et al. Duloxetine for the treatment of major depressive disorder: safety and tolerability associated with dose escalation. Depress Anxiety, 2007, 24(1): 41-52.
18.	Trivedi MH, Desaiah D, Ossanna MJ, et al. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol, 2008, 23(3): 161-169.
19.	Schueler YB, Koesters M, Wieseler B, et al. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatr Scand, 2011, 123(4): 247-265.
20.	Skljarevski V, Zhang S, Desaiah D, et al. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. J Pain, 2010, 11(12): 1282-1290.
21.	Fishbain DA, Hall J, Meyers AL, et al. Does pain mediate the pain interference with sleep problem in chronic pain? Findings from studies for management of diabetic peripheral neuropathic pain with duloxetine. J Pain Symptom Manage, 2008, 36(6): 639-647.
22.	Kluge M, Schüssler P, Steiger A, et al. Duloxetine increases stage 3 sleep and suppresses rapid eye movement (REM) sleep in patients with major depression. Eur Neuropsychopharmacol, 2007, 17(8): 527-531.
23.	Thase ME, Tran PV, Wiltse C, et al. Cardiovascular profile of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine. J Clin Psychopharmacol, 2005, 25(2): 132-140.
24.	Gahimer J, Wernicke J, Yalcin I, et al. A retrospective pooled analysis of duloxetine safety in 23,983 subjects. Curr Med Res Opin, 2007, 23(1): 175-184.
25.	Zhang L, Chappell J, Gonzales CR, et al. QT effects of duloxetine at supratherapeutic doses: a placebo and positive controlled study. J Cardiovasc Pharmacol, 2007, 49(3): 146-153.
26.	Xue F, Strombom I, Turnbull B, et al. Treatment with duloxetine in adults and the incidence of cardiovascular events. J Clin Psychopharmacol, 2012, 32(1): 23-30.
27.	Wernicke J, Lledó A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings from 42 placebo-controlled studies. Drug Saf, 2007, 30(5): 437-455.

1. Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry, 2001, 62 Suppl 16: 26-31.
2. Perahia DG, Quail D, Desaiah D, et al. Switching to duloxetine in selective serotonin reuptake inhibitor non- and partial-responders: effects on painful physical symptoms of depression. J Psychiatr Res, 2009, 43(5): 512-518.
3. Knadler MP, Lobo E, Chappell J, et al. Duloxetine: clinical pharmacokinetics and drug interactions. Clin Pharmacokinet, 2011, 50(5): 281-294.
4. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet, 2009, 373(9665): 746-758.
5. Cremers TI, Rea K, Bosker FJ, et al. Augmentation of SSRI effects on serotonin by 5-HT2C antagonists: mechanistic studies. Neuropsychopharmacology, 2007, 32(7): 1550-1557.
6. Gueorguieva R, Mallinckrodt C, Krystal JH. Trajectories of depression severity in clinical trials of duloxetine: insights into antidepressant and placebo responses. Arch Gen Psychiatry, 2011, 68(12): 1227-1237.
7. Maier W, Philipp M. Improving the assessment of severity of depressive states: a reduction of the Hamilton Depression Scale. Pharmacopsychiatry, 1985, 18: 114-115.
8. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
9. Detke MJ, Wiltse CG, Mallinckrodt CH, et al. Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Neuropsychopharmacol, 2004, 14(6): 457-470.
10. Perahia DG, Wang F, Mallinckrodt CH, et al. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry, 2006, 21(6): 367-378.
11. Lee P, Shu L, Xu X, et al. Once-daily duloxetine 60 mg in the treatment of major depressive disorder: multicenter, double-blind, randomized, paroxetine-controlled, non-inferiority trial in China, Korea, Taiwan and Brazil. Psychiatry Clin Neurosci, 2007, 61(3): 295-307.
12. 邱堂威, 彭德华, 刘敏. 度洛西汀与帕罗西汀治疗抑郁症对照分析. 中国民康医学, 2008, 20(23): 2772-2774.
13. 李雪汉. 盐酸度洛西汀治疗抑郁症的临床疗效和安全性. 河北医科大学学报, 2011, 32(2): 199-201.
14. 张雄, 马世发, 李亚军. 度洛西汀与帕罗西汀治疗抑郁症对照观察. 中外医学研究, 2011, 9(1): 16-17.
15. Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology, 2001, 25(6): 871-880.
16. Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs, 2009, 23(6): 523-541.
17. Wohlreich MM, Mallinckrodt CH, Prakash A, et al. Duloxetine for the treatment of major depressive disorder: safety and tolerability associated with dose escalation. Depress Anxiety, 2007, 24(1): 41-52.
18. Trivedi MH, Desaiah D, Ossanna MJ, et al. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol, 2008, 23(3): 161-169.
19. Schueler YB, Koesters M, Wieseler B, et al. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatr Scand, 2011, 123(4): 247-265.
20. Skljarevski V, Zhang S, Desaiah D, et al. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. J Pain, 2010, 11(12): 1282-1290.
21. Fishbain DA, Hall J, Meyers AL, et al. Does pain mediate the pain interference with sleep problem in chronic pain? Findings from studies for management of diabetic peripheral neuropathic pain with duloxetine. J Pain Symptom Manage, 2008, 36(6): 639-647.
22. Kluge M, Schüssler P, Steiger A, et al. Duloxetine increases stage 3 sleep and suppresses rapid eye movement (REM) sleep in patients with major depression. Eur Neuropsychopharmacol, 2007, 17(8): 527-531.
23. Thase ME, Tran PV, Wiltse C, et al. Cardiovascular profile of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine. J Clin Psychopharmacol, 2005, 25(2): 132-140.
24. Gahimer J, Wernicke J, Yalcin I, et al. A retrospective pooled analysis of duloxetine safety in 23,983 subjects. Curr Med Res Opin, 2007, 23(1): 175-184.
25. Zhang L, Chappell J, Gonzales CR, et al. QT effects of duloxetine at supratherapeutic doses: a placebo and positive controlled study. J Cardiovasc Pharmacol, 2007, 49(3): 146-153.
26. Xue F, Strombom I, Turnbull B, et al. Treatment with duloxetine in adults and the incidence of cardiovascular events. J Clin Psychopharmacol, 2012, 32(1): 23-30.
27. Wernicke J, Lledó A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings from 42 placebo-controlled studies. Drug Saf, 2007, 30(5): 437-455.

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Efficacy and Safety of Duloxetine versus Paroxetine for Adults’ Depression: A Meta-Analysis

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