Psychiatry Xagena

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Xagena Newsletter
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Depression: efficacy of Agomelatine similar to standard antidepressants

A systematic review and meta-analysis was performed on published and unpublished efficacy studies of Agomelatine in people with depression.

The eligibility criteria were double blind randomised placebo and comparator controlled trials of Agomelatine in depression with standard depression rating scales.
Studies were pooled by using a random effects model with DerSimonian and Laird weights for comparisons with placebo and comparator antidepressant.

The primary efficacy measure ( change in rating scale score ) was summarised with standardised mean difference ( SMD; a measure of effect size ) and secondary outcome measures with relative risks.
All results were presented with 95% confidence intervals.
Statistical heterogeneity was explored by visual inspection of funnel plots and by the I2 statistic.
Moderators of effect were explored by meta-regression.

Researchers identified 20 trials with 7460 participants meeting inclusion criteria ( 11 in the published literature, four from the European Medicines Agency [ EMA ] file, and five from the manufacturer ).

Almost all studies used the 17 item Hamilton depression rating scale ( score 0-50 ).

Agomelatine was significantly more effective than placebo with an effect size ( SMD ) of 0.24 ( 95% confidence interval 0.12 to 0.35 ) and relative risk of response 1.25 ( 1.11 to 1.4 ).

Compared with other antidepressants, Agomelatine showed equal efficacy ( SMD 0.00, −0.09 to 0.10 ).

Significant heterogeneity was uncovered in most analyses, though risk of bias was low.

Published studies were more likely than unpublished studies to have results that suggested advantages for Agomelatine.

In conclusion, Agomelatine is an effective antidepressant with similar efficacy to standard antidepressants. ( Xagena )

Taylor D et al, BMJ 2014;348:g1888