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Faculty of Pharmacy, University of Utrecht, Utrecht, Netherlands
Faculty of Pharmacy, University of Utrecht
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
Reprints: Dr. Einarson, Leslie Dan Faculty of Pharmacy, University of Toronto, 19 Russell St., Toronto, ON M5S 2S2, Canada, fax 416/978-1833, t.einarson{at}utoronto.ca
BACKGROUND: Duloxetine has joined venlafaxine on the antidepressant market as a second serotonin-norepinephrine reuptake inhibitor. No previous studies have directly compared these drugs.
OBJECTIVE: To compare indirectly the efficacy and safety of extended-release (XR) venlafaxine and duloxetine, the 2 currently available serotonin-norepinephrine reuptake inhibitors (SNRIs) in treating major depressive disorder.
METHODS: Outcomes from published, randomized, placebo-controlled
trials reporting on moderately to severely depressed patients (Hamilton Rating
Scale for Depression [HAM-D] 
15 or Montgomery-Åsberg Depression
Rating Scale [MADRS] 18). A systematic literature search of Cochrane,
EMBASE, and MEDLINE (1996-January 2005) was performed. Two independent
reviewers judged the trials for acceptance, and last observation carried
forward data were extracted. Differences in remission (8-week HAM-D score
7 or MADRS 10), response (50% decrease on either scale), and dropout
rates from lack of efficacy and adverse events were meta-analyzed using a
random effects model. Each rate was contrasted with placebo. Sensitivity
analyses were performed to examine the robustness of the results.
RESULTS: Data were obtained from 8 trials evaluating 1754 patients for efficacy and 1791 patients for discontinuation/safety. Venlafaxine-XR rates were 17.8% (95% CI 9.0 to 26.5) and 24.4% (95% CI 15.0 to 37.7) greater than those with placebo for remission and response compared with 14.2% (95% CI 8.9 to 26.5) and 18.6% (95% CI 13.0 to 24.2) for duloxetine. Although numerically higher for venlafaxine-XR, no statistically significant differences were found between the drugs; however, both demonstrated overall remission and response rates significantly higher than the rates achieved with placebo (p < 0.001). Reported adverse events were comparable between drugs.
CONCLUSIONS: Venlafaxine-XR tends to have a favorable trend in remission and response rates compared with duloxetine. However, dropout rates and adverse events did not differ. A direct comparison is warranted to confirm this tendency.
Key Words: depression, major depressive disorder; duloxetine, venlafaxine-XR
Published Online, September 27, 2005. www.theannals.com, DOI 10.1345/aph.1G076
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