Comparative efficacy of selective serotonin reuptake inhibitors (SSRI) in treating major depressive disorder: a protocol for network meta-analysis of randomised controlled trials

IntroductionThere have been inconsistent findings from randomised controlled trials (RCTs) and systematic reviews on the efficacies of selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment of major depressive disorder (MDD). Besides inconsistencies among randomised controlled t...

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Bibliographic Details
Published in:BMJ open 2016-06, Vol.6 (6), p.e010142-e010142
Main Authors: Jia, Yongliang, Zhu, Hongmei, Leung, Siu-wai
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antidepressants
Bayes Theorem
Bias
Depressive Disorder, Major - drug therapy
Evidence Based Practice
Female
Humans
Male
Meta-analysis
Middle Aged
Network Meta-Analysis
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Research Design
Retrospective Studies
Serotonin Uptake Inhibitors - therapeutic use
Studies
Systematic review
Young Adult
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Summary:IntroductionThere have been inconsistent findings from randomised controlled trials (RCTs) and systematic reviews on the efficacies of selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment of major depressive disorder (MDD). Besides inconsistencies among randomised controlled trials (RCTs), their risks of bias and evidence grading have seldom been evaluated in meta-analysis. This study aims to compare the efficacy of SSRIs by conducting a Bayesian network meta-analysis, which will be the most comprehensive evaluation of evidence to resolve the inconsistency among previous studies.Methods and analysesSSRIs including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and vilazodone have been selected. Systematic database searching and screening will be conducted for the RCTs on drug treatment of patients with MDD according to pre-specified search strategies and selection criteria. PubMed, the Cochrane Library, EMBASE, ScienceDirect, the US Food and Drug Administration Website, ClinicalTrial.gov and WHO Clinical Trials will be searched. Outcome data including Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) from eligible RCTs will be extracted. The outcomes will be analysed as ORs and mean differences under a random-effects model. A Bayesian network meta-analysis will be conducted with WinBUGS software, to compare the efficacies of SSRIs. Subgroup and sensitivity analysis will be performed to explain the study heterogeneity and evaluate the robustness of the results. Meta-regression analysis will be conducted to determine the possible factors affecting the efficacy outcomes. The Cochrane risk of bias assessment tool will be used to assess the RCT quality, and the Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the strength of evidence from the meta-analysis.Ethics and disseminationNo ethical approval is required because this study includes neither confidential personal patient data nor interventions with patients.Protocol registration numberCRD42015024879.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2015-010142