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Text of the page (random words):
afaxine versus ssris reflected an average difference in remission rates of 5 9 which reflected a nnt of 17 1 059 that is one would expect to treat approximately 17 patients with venlafaxine to see one more success than if all had been treated with another ssri although this difference was reliable and would be important if applied to populations of depressed patients it is also true that it is modest and might not be noticed by busy clinicians in everyday practice nonetheless an nnt of 17 may be of public health relevance given the large number of patients treated for depression and the significant burden of illness associated with this disorder my emphasis as i wrote then the benefit to public health claim is ridiculous to understand the reasons why this is so laughable please check out my prior post on the topic this meta analysis included a bunch of data from wyeth that was previously unpublished which leads to the freshly published meta analysis on how effexor compares to ssris the german researchers requested unpublished data from wyeth and only got some of it you d think that just maybe wyeth sent them the good news data and maybe held back on some of the bad news data so when an ever so small benefit emerged for effexor 5 high treatment response rate well call me crazy but i ignored it we re not playing with a full dataset because the manufacturer wants to keep some of it hidden so shame on wyeth and let s look at effexor with a little bit of suspicion so effexor vs ssris no difference except that more people drop out of clinical trials on effexor due to side effects compared to ssris about 3 more so even if you believe that wyeth s hidden data really doesn t impact these findings we re left with a very small advantage for effexor that is probably negated by its slightly higher dropout rates cymbalta it had a 3 higher dropout rate due to adverse events and the same efficacy as ssris so nothing to write home about except that it costs a boatload more than generic ssris and is harder to tolerate but cymbalta has been marketed to the gills and is clearing 3 billion a year in sales hey this is the company marketed zyprexa for dementia oops and for well lots of other stuff 1 2 so it s not surprising at all that they can take a mediocre antidepressant like cymbalta and turn it into a big moneymaker the wonders of a good marketing department but depression hurts and cymbalta is a painkiller well that s fine and dandy until you actually look at the data which show cymbalta doesn t do much for pain in depression it s time to get over the hype surrounding snris the next advance in antidepressants well who knows what it will be but let s hope it s something a little more substantial than snris but i m not hopeful and no i don t want to hear anything more about agomelatine i know it s been a long time between posts so pardon me if my writing is more awful than usual and it doesn t mean i will be posting regularly thanks to the multiple readers who sent me a copy of this article citation to new meta analysis of effexor and cymbalta schueler y koesters m wieseler b grouven u kromp m kerekes m kreis j kaiser t becker t weinmann s 2010 a systematic review of duloxetine and venlafaxine in major depression including unpublished data acta psychiatrica scandinavica doi 10 1111 j 1600 0447 2010 01599 x posted by cl psych at 10 01 2010 11 13 00 am 5 comments labels antidepressants cymbalta effexor ssris friday may 14 2010 eli lilly our drug failed so it has serious potential these folks at lilly must think we are exceptionally stupid as in can t tie our own shoes a study in the journal of psychiatric research recently found that their experimental antidepressant ly2216684 was no better than placebo here are a couple of quotes from the abstract ly2216684 did not show statistically significant improvement from baseline compared to placebo in the primary analysis of the hamilton depression rating scale ham d17 total score escitalopram demonstrated significant improvement compared to placebo on the ham d17 total score suggesting adequate assay sensitivity on the primary outcome measure the experimental drug failed whereas lexapro worked to some extent i know what you re thinking the sample size was probably too small to find a significant effect um you re wrong how about 269 people on the lilly drug 138 on placebo and 62 on lexapro but wait here comes the good news both ly2216684 and escitalopram showed statistically significant improvement from baseline on the patient rated qids sr total score compared to placebo the results of this initial investigation of ly2216684 s efficacy suggest that it may have antidepressant potential the good news for lilly is that most people who claim to read journal articles really just browse the abstract without actually looking at the full text of the paper for the select few who have nothing better to do than read lilly propaganda take a look at table 2 a total of 12 secondary outcome measures are listed the lilly drug beat placebo on one of them lilly doesn t say much about how much better their drug was than placebo on the qids sr measure beside throwing around that often meaningless term of statistically significant people on the drug improved by 10 2 points whereas placebo patients improved 8 3 points so about a 20 difference if you bother to calculate an effect size it is d 24 which is quite small and clinically insignificant so on the one measure where the drug was better than placebo it was by a small margin and it missed the mark on 11 other secondary measures as well as on the primary outcome measure but it may have antidepressant potential hell yes i ve never been so exited about a new drug by the way lilly is apparently trying this wonder drug out in at least five trials the journal in which this article appeared has published other dubious eli lilly research in the past the editorial review process is clearly working wonders over at the journal of psychiatric research sad really the journal publishes some really good work but then runs this kind of junk as well depression self report sidebar the self reported measure on which the drug had an advantage the quick inventory of depressive symptoms qids it s really awesome according to lilly remember it s the only measure on which their experimental failure drug had an advantage over placebo so the authors wrote self reported depression symptoms such as those obtained by the qids sr may be more sensitive than clinician administered scales for signal detection in clinical studies of depression what does bristol myers squibb think in three trials of abilify for depression self reports of depression were unfavorable so the publications for these studies made sure to downplay these depression self reports by saying that these measures were not sensitive that they weren t picking up improvements in depression so if a self report provided positive results then bam it s an awesome measure of depression but if it provided negative results then it s a horrendously inaccurate measure and should never have been used in the first place citation below yes one of the authors last names is kielbasa dubé s dellva m jones m kielbasa w padich r saha a rao p 2010 a study of the effects of ly2216684 a selective norepinephrine reuptake inhibitor in the treatment of major depression journal of psychiatric research 44 6 356 363 doi 10 1016 j jpsychires 2009 09 013 posted by cl psych at 5 14 2010 08 18 00 am 13 comments labels antidepressants journals lilly science friday april 02 2010 charles nemeroff consultant extraordinaire the key opinion leader of key opinion leaders or boss of bosses if you prefer in any case take a peek at the following from charles nemeroff s page on the university of miami s website seems like something must have happened in 2006 to slow down chuck s momentum what this is old news yeah i know but i just hadn t written much about our friends in the world of drug sales academics lately so i just had to do this pharmaceutical and clinical research company scientific advisory boards abbott laboratories consultant abbott laboratories diagnostics division 1986 1992 research and education advisory board for psychiatry member 1990 2006 executive board 1991 1993 2003 2006 antidepressant advisory board 1991 1992 acadia pharmaceuticals clinical advisory board member 2000 2006 astrazeneca pharmaceuticals psychiatry advisory board 1997 2001 chairman 1999 2002 neuroscience scientific advisory board 1999 present bristol myers squibb antipsychotic advisory board 2003 2006 antidepressant advisory board 2003 2006 emsam advisory board chairman 2005 2006 cephalon pharmaceuticals scientific advisory board 2002 comprehensive neuroscience inc scientific advisory board 1999 2004 corcept scientific advisory board 2001 2006 cyberonics scientific advisory board 2002 2006 chair mechanism of action board 2003 2006 cypress biosciences inc board of directors 2001 2004 consultant 2004 2006 eli lilly and company psychiatry advisory board 1990 2000 bipolar advisory board 1998 1999 consultant 2002 2003 global neuroscience advisory board 2005 2006 forest laboratories citalopram clinical advisory board 1997 2002 psychiatry scientific advisory board chairman 1999 2008 glaxosmithkline advisory board of psychiatrists chairman 1991 2004 janssen pharmaceuticals mood disorders advisory board member and chairman 1998 2004 topiramate advisory board member and chairman 1999 2001 antipsychotic advisory board member 1999 present johnson johnson scientific advisory board 2007 present lundbeck consultant 2006 merck sharp dohme research laboratories consultant neuroscience research center 1994 mood disorders advisory board 1999 2003 merck medco mental health advisory board member 1996 1998 mt cook pharma board of directors 2007 present neurocrine biosciences scientific advisory board 1994 2004 neuronetics scientific advisory board 2006 novadel pharma board of directors 2003 present chair scientific advisory committee member compensation committee member nominating committee novartis pharmaceutical company bipolar advisory board chairman 2001 2003 pediatric bipolar advisory board 2002 2003 antidepressant advisory board 2006 organon pharmaceuticals psychiatry advisory board member 1997 2004 otsuka psychiatry advisory board chairman 2003 2006 pharmaneuroboost scientific advisory board 2006 present pfizer pharmaceuticals clinical neuroscience advisory board 2004 2006 chair antipsychotic advisory board 2004 2006 quintiles scientific advisory board 2004 present revaax stockholder roche laboratories a division of hoffman laroche inc mania advisory board 1993 pharmocogenomics advisory board 2006 sanofi synthelabo psychiatry advisory board 2002 2005 scirex scientific advisory board 1999 2003 solvay pharmaceuticals psychiatry advisory board member 1991 1999 chairman 1991 1999 antipsychotic advisory board 2005 2006 somerset pharmaceuticals psychiatry advisory board chair 2000 2004 vela pharmaceuticals scientific advisory board 2001 2002 wyeth ayerst psychiatric advisory board chairman and member 1995 2002 posted by cl psych at 4 02 2010 12 16 00 pm 10 comments tuesday march 16 2010 research blogging awards 2010 holy cow i ve been nominated for an award under the category of best health blog with eight other nominees voting is already closed and i can pretty much guarantee i didn t win but it s an honor to have been nominated posted by cl psych at 3 16 2010 06 52 00 am 6 comments editorial support cme and the primary care companion by now everyone who has been paying attention should know that a journal article which lists editorial support is an article that was ghostwritten yet the average reader of these articles is apparently uninformed enough to not care why else would so many articles get published which feature editorial support provided by insert name of ghostwriter here one my my favorite journals under the so bad it s good category is the primary care companion to the journal of clinical psychiatry good articles certainly make their way into the journal perhaps by accident but the journal can always be counted on to provide a steady supply of utter garbage here s the acknowledgements section from one recent piece in the journal editorial support was provided by george rogan msc phase five communications inc new york new york mr rogan reports no other financial affiliations relevant to the subject of this article and in case you re wondering funding for editorial support was provided by bristol myers squibb if you ve somehow guessed that this is an advertorial for abilify you win other ghostwritten pieces of fluff paid for by bms include an article discussing the safety profile of abilify in depression it states that in conclusion this post hoc analysis extends previous findings demonstrating that aripiprazole is safe and generally well tolerated as an augmentation strategy to standard adt in patients with mdd with a history of an inadequate response to antidepressant medication but abilify caused akathisia in a quarter of patients i think that s a problem but wait there s more an article based on data from two trials which showed allegedly that seroquel improves anxiety in patients with bipolar disorder this piece also acknowledges that it was ghostwritten and we know that astrazeneca manufacturer of seroquel has cooked the books on seroquel in the past feel free to look through the journal every month and have a giggle at some of the ridiculous pieces that make their way into print cme you can get your continuing medical education cme from the primary care companion as well one particularly awesome piece of medical wisdom pimped abilify educated physicians about the best ways to manage resistant depression this one is a beauty it was supported by cash from bms which features prominently in the treat aggressively message of the piece the article features none other than michael thase as the leading discussant the same guy who was the leading author on a paper which allegedly showed the wonders of abilify for depression despite the pesky fact that patients said it didn t work back to the cme thase starts off by stating that only a third of patients achieve remission of depressive symptoms during treatment given that abilify is being marketed for treatment resistant depression this is a perfect way to start off this infomercial educational piece he adds that failure to achieve remission increases the risk of suicide and puts people at risk for more depression worse psychiatric outcomes and all sorts of other bad things so we better get rid of all symptoms of depression thase suggests that clinicians should closely monitor patients to see if their symptoms are remitting in particular relying on the global statement i m definitely better from the patient overlooks persistent minor or residual symptoms dr thase recommended using a standardized symptom assessment measure and keeping track of t...
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