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Antidepressant prescriptions have not fully reflected evolving evidence from cumulative network meta-analyses and guideline recommendations.

Authors
  • Luo, Yan1
  • Ostinelli, Edoardo G2
  • Sahker, Ethan3
  • Chaimani, Anna4
  • Kataoka, Yuki5
  • Ogawa, Yusuke6
  • Cipriani, Andrea2
  • Salanti, Georgia7
  • Furukawa, Toshi A8
  • 1 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto 606-8501, Japan. , (Japan)
  • 2 Department of Psychiatry, University of Oxford, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK.
  • 3 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto 606-8501, Japan; Overseas Fellowship Division, Japanese Society for the Promotion of Science (JSPS), Tokyo 102-0083, Japan. , (Japan)
  • 4 Research Center of Epidemiology and Statistics, Université de Paris (CRESS-UMR1153), INSERM, INRA, Paris F-75004, France. , (France)
  • 5 Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo 660-8550, Japan. , (Japan)
  • 6 Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto 606-8501, Japan. , (Japan)
  • 7 Institute of Social and Preventive Medicine, University of Bern, Bern CH-3012, Switzerland. , (Switzerland)
  • 8 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto 606-8501, Japan. Electronic address: [email protected] , (Japan)
Type
Published Article
Journal
Journal of clinical epidemiology
Publication Date
May 01, 2021
Volume
133
Pages
14–23
Identifiers
DOI: 10.1016/j.jclinepi.2020.12.023
PMID: 33359320
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study compares three major elements of evidence-based medicine (EBM) practices, namely evidence synthesis, clinical practice guidelines (CPGs), and real-world prescriptions in the United States, regarding antidepressant treatments of major depression over the past 3 decades. We conducted network meta-analyses (NMAs) of antidepressants every 5 years up to 2016 based on a comprehensive data set of double-blind randomized controlled trials. We identified CPGs and extracted their recommendations. We surveyed the prescriptions in the United States at 5-year intervals up to 2015. Most drugs recommended by CPGs presented favorable performance in efficacy and acceptability in NMAs. However, CPG recommendations were often in terms of drug classes rather than individual drugs, whereas NMAs suggested distinctive difference between drugs within the same class. The update intervals of all CPGs were longer than 5 years. All the antidepressants prescribed frequently in the United States were recommended by CPGs. However, changes in prescriptions did not correspond to alterations in CPGs or to apparent changes in the effects indicated by NMAs. Many factors including marketing efforts, regulations, or patient values may have played a role. Enhancements including accelerating CPG updates and monitoring the impact of marketing on prescriptions should be considered in future EBM implementation. Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.

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