Kornstein Susan G, Wohlreich Madelaine M, Mallinckrodt Craig H, Watkin John G, Stewart Donna E
Department of Psychiatry, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, USA.
J Clin Psychiatry. 2006 May;67(5):761-70. doi: 10.4088/jcp.v67n0510.
A number of studies have suggested potential gender differences in the efficacy of antidepressant medications. Pooled data from double-blind, placebo-controlled studies were utilized to compare the efficacy of duloxetine in the treatment of major depressive disorder (MDD) in male and female patients.
Efficacy data were pooled from 7 randomized, double-blind, placebo-controlled clinical trials of duloxetine. These studies represent all available data from U.S. acute-phase, placebo-controlled studies of duloxetine for the treatment of MDD. Patients (aged > or = 18 years) meeting DSM-IV criteria for MDD received duloxetine (40-120 mg/day; men, N = 318; women, N = 578) or placebo (men, N = 242; women, N = 484) for up to 9 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAM-D17) total score, HAM-D17 subscales (core, Maier, anxiety, retardation, sleep), the Clinical Global Impressions-Severity of Illness scale (CGI-S) and Patient Global Impression of Improvement scale (PGI-I), the Quality of Life in Depression Scale (QLDS), and Visual Analog Scales (VAS) for pain. The first patient visit was February 1, 1999, and the last patient visit was November 27, 2002.
In both male and female patients, duloxetine produced significantly greater improvement in HAM-D17, CGI-S, and PGI-I when compared with placebo (p < .05). Treatment-by-gender interactions did not reach statistical significance, indicating that the magnitude of duloxetine's treatment effects did not differ significantly between male and female patients. However, there was a trend for female patients to show a more robust response than male patients to both duloxetine and placebo. On the basis of VAS assessments of pain severity, duloxetine-treated female patients appeared to exhibit greater improvement than male patients, while women receiving placebo had smaller responses than placebo-treated men. Improvements in quality of life were significantly greater for both men (p = .006) and women (p = .001) receiving duloxetine than placebo and showed no significant difference by gender.
In this analysis of pooled data, the efficacy of duloxetine did not differ significantly in male and female patients.
多项研究表明抗抑郁药物的疗效可能存在性别差异。利用双盲、安慰剂对照研究的汇总数据来比较度洛西汀治疗男性和女性患者重度抑郁症(MDD)的疗效。
疗效数据来自7项度洛西汀的随机、双盲、安慰剂对照临床试验。这些研究代表了美国度洛西汀治疗MDD急性期、安慰剂对照研究的所有可用数据。符合DSM-IV标准的MDD患者(年龄≥18岁)接受度洛西汀(40 - 120毫克/天;男性,N = 318;女性,N = 578)或安慰剂(男性,N = 242;女性,N = 484)治疗长达9周。疗效指标包括17项汉密尔顿抑郁评定量表(HAM-D17)总分、HAM-D17分量表(核心、迈尔、焦虑、迟缓、睡眠)、临床总体印象-疾病严重程度量表(CGI-S)和患者总体改善印象量表(PGI-I)、抑郁生活质量量表(QLDS)以及疼痛视觉模拟量表(VAS)。首例患者访视时间为1999年2月1日,最后一例患者访视时间为2002年11月27日。
与安慰剂相比,度洛西汀在男性和女性患者中均使HAM-D17、CGI-S和PGI-I有显著更大程度的改善(p < .05)。性别与治疗的交互作用未达到统计学显著性,表明度洛西汀治疗效果的程度在男性和女性患者之间无显著差异。然而,有一个趋势是女性患者对度洛西汀和安慰剂的反应比男性患者更强烈。基于VAS对疼痛严重程度的评估,度洛西汀治疗的女性患者似乎比男性患者改善更大,而接受安慰剂的女性比接受安慰剂的男性反应更小。接受度洛西汀的男性(p = .006)和女性(p = .001)的生活质量改善均显著大于接受安慰剂的患者,且按性别无显著差异。
在对汇总数据的该分析中,度洛西汀在男性和女性患者中的疗效无显著差异。