Psychiatry Investig.  2014 Oct;11(4):371-379. 10.4306/pi.2014.11.4.371.

A Meta-Analysis Comparing Open-Label versus Placebo- Controlled Clinical Trials for Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: Lessons and Promises

Affiliations
  • 1Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea. pae@catholic.ac.kr
  • 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duram, NC, USA.
  • 3Department of Neuropsychiatry, College of Medicine, Hallym University, Seoul, Republic of Korea.
  • 4Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
  • 5Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • 6Department of Psychiatry, Kyunghee University College of Medicine, Seoul, Republic of Korea.
  • 7Department of Neuropsychiatry, School of Medicine, Dongguk University, Gyeongju, Republic of Korea.
  • 8Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.

Abstract


OBJECTIVE
The present study is to provide whether open-label studies (OLS) may properly foresee the efficacy of randomized, placebo-controlled trials (RCTs) using OLSs and RCTs data for aripiprazole in the treatment of MDD, with the use of meta-analysis approach.
METHODS
A search of the studies used the key terms "depression and aripiprazole" from the databases of PubMed/PsychInfo from Jan 2005 through July 2013. The data were selected and verified for publication in English-based peer-reviewed journals based on rigorous inclusion criteria. Extracted data were delivered into and run by the Comprehensive Meta Analysis program v2.
RESULTS
The pooled SMDs for the primary efficacy measure was statistically significant, pointing out the significant reduction of depressive symptoms after aripiprazole augmentation (AA) to current antidepressant treatment in OLSs (pooled SMD=-2.114, z=-9.625, p<0.001); similar results were also found in RCTs (pooled SMD=-2.202, z=-6.862, p<0.001). The meta-regression analysis revealed no influence of the study design for treatment outcome.
CONCLUSION
There was no difference in the treatment effects of aripiprazole as an augmentation therapy in both OLSs and RCTs, indicating that open-label design may be a potentially useful predictor for treatment outcomes of controlled-clinical trials. The proper conduction of OLSs may provide informative, useful and preliminary clinical data and factors to be involved in controlled-clinical trials, by which we may have better understanding on the role of AA (e.g., dosing issues, proper duration of treatment, specific population for AA) implicated in the treatment of MDD in clinical practice.

Keyword

Open-label study; Randomized-controlled clinical trials; Aripiprazole; Augmentation; Depression

MeSH Terms

Depression
Depressive Disorder, Major*
Publications
Treatment Outcome
Aripiprazole
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