Examining the efficacy of adjunctive aripiprazole in major depressive disorder: A pooled analysis of 2 studies

Michael E. Thase, Madhukar H. Trivedi, J. Craig Nelson, Maurizio Fava, Rene Swanink, Quynh Van Tran, Andrei Pikalov, Huyuan Yang, Berit X. Carlson, Ronald N. Marcus, Robert M. Berman

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Patients with major depressive disorder (MDD) who fail to achieve complete remission with antidepressant therapy may benefit from augmentation therapy with an atypical antipsychotic. Method: A pooled analysis was performed on 2 identical 14-week studies (8-week prospective antidepressant therapy treatment phase followed by 6-week randomized double-blind phase) evaluating the efficacy of adjunctive aripiprazole (2-20 mg/day) in DSM-IV-TR-defined MDD patients with an inadequate response to antidepressant therapy. Primary efficacy endpoint was the mean change in Montgomery-Asberg Depression Rating Scale (MADRS) total score from end of the prospective phase (week 8) to end of randomized phase (week 14, last observation carried forward). Subgroup analyses were performed. The key secondary endpoint was mean change in Sheehan Disability Scale (SDS) mean score. Results: At endpoint, mean change in MADRS total score was significantly greater with adjunctive aripiprazole (-8.7) than with adjunctive placebo (-5.7; p < .001). Except for a differential treatment-by-sex interaction, change in MADRS total scores were consistently greater with adjunctive aripiprazole than with adjunctive placebo, regardless of race, age, episode duration, prior antidepressant therapy response, number of historical treatment failures, severity of depressive symptoms, and antidepressant. At endpoint, MADRS remission rates were significantly greater with adjunctive aripiprazole than with placebo (25.7% vs. 15.4%; p < .001). Adjunctive aripiprazole also demonstrated significantly greater improvements in mean change from baseline in SDS total score than adjunctive placebo (-1.2 vs. -0.6; p = .001). Conclusion: Augmentation of antidepressant therapy with the atypical antipsychotic aripiprazole resulted in significant efficacy benefits across a range of subgroups of patients with MDD. Further study of a treatment-by-sex interaction is needed. Trial Registration: www.clinicaltrials. gov Identifiers: NCT00095823 and NCT00095758.

Original languageEnglish (US)
Pages (from-to)440-447
Number of pages8
JournalPrimary Care Companion to the Journal of Clinical Psychiatry
Volume10
Issue number6
DOIs
StatePublished - 2008

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Major Depressive Disorder
Antidepressive Agents
Depression
Placebos
Therapeutics
Antipsychotic Agents
Aripiprazole
Treatment Failure
Diagnostic and Statistical Manual of Mental Disorders
Observation

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Examining the efficacy of adjunctive aripiprazole in major depressive disorder : A pooled analysis of 2 studies. / Thase, Michael E.; Trivedi, Madhukar H.; Nelson, J. Craig; Fava, Maurizio; Swanink, Rene; Tran, Quynh Van; Pikalov, Andrei; Yang, Huyuan; Carlson, Berit X.; Marcus, Ronald N.; Berman, Robert M.

In: Primary Care Companion to the Journal of Clinical Psychiatry, Vol. 10, No. 6, 2008, p. 440-447.

Research output: Contribution to journalArticle

Thase, ME, Trivedi, MH, Nelson, JC, Fava, M, Swanink, R, Tran, QV, Pikalov, A, Yang, H, Carlson, BX, Marcus, RN & Berman, RM 2008, 'Examining the efficacy of adjunctive aripiprazole in major depressive disorder: A pooled analysis of 2 studies', Primary Care Companion to the Journal of Clinical Psychiatry, vol. 10, no. 6, pp. 440-447. https://doi.org/10.4088/PCC.v10n0603
Thase, Michael E. ; Trivedi, Madhukar H. ; Nelson, J. Craig ; Fava, Maurizio ; Swanink, Rene ; Tran, Quynh Van ; Pikalov, Andrei ; Yang, Huyuan ; Carlson, Berit X. ; Marcus, Ronald N. ; Berman, Robert M. / Examining the efficacy of adjunctive aripiprazole in major depressive disorder : A pooled analysis of 2 studies. In: Primary Care Companion to the Journal of Clinical Psychiatry. 2008 ; Vol. 10, No. 6. pp. 440-447.
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abstract = "Background: Patients with major depressive disorder (MDD) who fail to achieve complete remission with antidepressant therapy may benefit from augmentation therapy with an atypical antipsychotic. Method: A pooled analysis was performed on 2 identical 14-week studies (8-week prospective antidepressant therapy treatment phase followed by 6-week randomized double-blind phase) evaluating the efficacy of adjunctive aripiprazole (2-20 mg/day) in DSM-IV-TR-defined MDD patients with an inadequate response to antidepressant therapy. Primary efficacy endpoint was the mean change in Montgomery-Asberg Depression Rating Scale (MADRS) total score from end of the prospective phase (week 8) to end of randomized phase (week 14, last observation carried forward). Subgroup analyses were performed. The key secondary endpoint was mean change in Sheehan Disability Scale (SDS) mean score. Results: At endpoint, mean change in MADRS total score was significantly greater with adjunctive aripiprazole (-8.7) than with adjunctive placebo (-5.7; p < .001). Except for a differential treatment-by-sex interaction, change in MADRS total scores were consistently greater with adjunctive aripiprazole than with adjunctive placebo, regardless of race, age, episode duration, prior antidepressant therapy response, number of historical treatment failures, severity of depressive symptoms, and antidepressant. At endpoint, MADRS remission rates were significantly greater with adjunctive aripiprazole than with placebo (25.7{\%} vs. 15.4{\%}; p < .001). Adjunctive aripiprazole also demonstrated significantly greater improvements in mean change from baseline in SDS total score than adjunctive placebo (-1.2 vs. -0.6; p = .001). Conclusion: Augmentation of antidepressant therapy with the atypical antipsychotic aripiprazole resulted in significant efficacy benefits across a range of subgroups of patients with MDD. Further study of a treatment-by-sex interaction is needed. Trial Registration: www.clinicaltrials. gov Identifiers: NCT00095823 and NCT00095758.",
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AU - Nelson, J. Craig

AU - Fava, Maurizio

AU - Swanink, Rene

AU - Tran, Quynh Van

AU - Pikalov, Andrei

AU - Yang, Huyuan

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