Vortioxetine for Depression in Adults

Summary

A Cochrane review [Abstract] 1 included 15 studies with a total of 7746 subjects. Seven studies were placebo controlled; eight studies compared vortioxetine to serotonin-norepinephrine reuptake inhibitors (SNRIs). There were no studies that compared vortioxetine to selective serotonin reuptake inhibitors (SSRIs).

• Vortioxetine vs. placebo: Vortioxetine was more efficacious across 3 efficacy outcomes: response (RR 1.35, 95% CI 1.22 to 1.49; 14 studies, n=6220), remission (RR 1.32, 95% CI 1.15 to 1.53; 14 studies, n=6220) and depressive symptoms measured using the Montgomery-Åsberg Depression Scale (MADRS) (MD -2.94, 95% CI -4.07 to -1.80; 14 studies, n=5566). There was no evidence of a difference in total dropout rates (RR 1.05, 95% CI 0.93 to 1.19; 14 studies, n=6220). More patients discontinued vortioxetine than placebo because of adverse effects (RR 1.41, 95% CI 1.09 to 1.81; 14 studies, n=6220) but fewer discontinued due to inefficacy (RR 0.56, 95% CI 0.34 to 0.90; 14 studies, n=6220).
• Vortioxetine vs. other antidepressants:There were no clinically significant difference between vortioxetine and SNRIs as a class for response (RR 0.91, 95% CI 0.82 to 1.00; 8 studies, n=3159) or remission (RR 0.89, 95% CI 0.77 to 1.03; 8 studies, n=3155). There was a small difference favouring SNRIs for depressive symptom scores on the MADRS (MD 1.52, 95% CI 0.50 to 2.53; 8 studies, n=2807). There were no significant differences between vortioxetine and the SNRIs as a class for total dropout rates (RR 0.89, 95% CI 0.73 to 1.08; 8 studies, n=3159), dropouts due to adverse events (RR 0.74, 95% CI 0.51 to 1.08) and dropouts due to inefficacy (RR 1.52, 95% CI 0.70 to 3.30).Vortioxetine may be less effective than duloxetine in terms of response rates (RR 0.86, 95% CI 0.79 to 0.94; 6 studies, n=2392) and depressive symptoms scores on the MADRS scale (MD 1.99, 95% CI 1.15 to 2.83; 6 studies; n=2106). Against venlafaxine, meta-analysis of two studies found no statistically significant differences (response: RR 1.03, 95% CI 0.85 to 1.25; n=767; depressive symptom scores: MD 0.02, 95% CI -2.49 to 2.54; n=701). In terms of number of participants reporting at least one adverse effect (tolerability), vortioxetine was better than the SNRIs as a class (RR 0.90, 95% CI 0.86 to 0.94; 8 studies, n=3134) and duloxetine (RR 0.89, 95% CI 0.84 to 0.95; 6 studies; n=2376).