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Raising Placebo Efficacy in Antidepressant Trials Across Decades Explained by Small-Study Effects: A Meta-Reanalysis


Holper, Lisa (2020). Raising Placebo Efficacy in Antidepressant Trials Across Decades Explained by Small-Study Effects: A Meta-Reanalysis. Frontiers in Psychiatry, 11:633.

Abstract

Background: Recent meta-analyses reported placebo response rate in antidepressant trials to be stable since the 1970s. These meta-analyses however were limited in considering only linear time trends, assessed trial-level covariates based on single-model hypothesis testing only, and did not adjust for small-study effects (SSE), a well-known but not yet formally assessed bias in antidepressant trials.

Methods: This secondary meta-analysis extends previous work by modeling nonlinear time trends, assessing the relative importance of trial-level covariates using a multimodel approach, and rigorously adjusting for SSE. Outcomes were placebo efficacy (continuous), based on the Hamilton Depression Scale, and placebo response rate.

Results: Results suggested that any nonlinear time trends in both placebo efficacy (continuous) and response rate were best explained by SSE. Adjusting for SSE revealed a significant gradual increase in placebo efficacy (continuous) from 1979 to 2014. A similar observation was made for placebo response rate, but did not reach significance due higher susceptibility to SSE. By contrast, trial-level covariates alone were found to be insufficient in explaining time trends.

Conclusion: The present findings contribute to the ongoing debate on antidepressant placebo outcomes and highlight the need to adjust for bias introduced by SSE. The results are of clinical relevance because SSE may affect the evaluation of success or failure in antidepressant trials.

Abstract

Background: Recent meta-analyses reported placebo response rate in antidepressant trials to be stable since the 1970s. These meta-analyses however were limited in considering only linear time trends, assessed trial-level covariates based on single-model hypothesis testing only, and did not adjust for small-study effects (SSE), a well-known but not yet formally assessed bias in antidepressant trials.

Methods: This secondary meta-analysis extends previous work by modeling nonlinear time trends, assessing the relative importance of trial-level covariates using a multimodel approach, and rigorously adjusting for SSE. Outcomes were placebo efficacy (continuous), based on the Hamilton Depression Scale, and placebo response rate.

Results: Results suggested that any nonlinear time trends in both placebo efficacy (continuous) and response rate were best explained by SSE. Adjusting for SSE revealed a significant gradual increase in placebo efficacy (continuous) from 1979 to 2014. A similar observation was made for placebo response rate, but did not reach significance due higher susceptibility to SSE. By contrast, trial-level covariates alone were found to be insufficient in explaining time trends.

Conclusion: The present findings contribute to the ongoing debate on antidepressant placebo outcomes and highlight the need to adjust for bias introduced by SSE. The results are of clinical relevance because SSE may affect the evaluation of success or failure in antidepressant trials.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Psychiatry and Mental Health
Uncontrolled Keywords:Psychiatry and Mental health
Language:English
Date:28 July 2020
Deposited On:22 Jan 2021 06:27
Last Modified:01 Feb 2021 16:27
Publisher:Frontiers Research Foundation
ISSN:1664-0640
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.3389/fpsyt.2020.00633
PubMed ID:32848900
Project Information:
  • : FunderSNSF
  • : Grant ID320030_184755
  • : Project TitleBrain cytochrome-c-oxidase assessed by NIRS as mitochondrial biomarker in depression

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