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• W2107173600 abstract "La dépression majeure, d’autant plus qu’elle est sévère, entraîne un retentissement fonctionnel et social important, associé à une morbimortalité accrue. L’observance thérapeutique, largement tributaire de la tolérance, est cruciale pour les traitements médicamenteux antidépresseurs de longue durée. Les études publiées révèlent des différences importantes, cliniques et statistiques, entre les différents antidépresseurs. La méta-analyse en réseau de Cipriani et al. (2009) valorise l’escitalopram et la sertraline en termes d’efficacité clinique et d’acceptabilité à huit semaines. L’analyse poolée de Kasper et al. (2009) met en exergue une meilleure efficacité et tolérance à six mois de l’escitalopram comparé à la paroxétine. L’analyse poolée de Wade et al. (2009) portait sur quatre essais randomisés d’une durée de six mois dans la dépression, en double insu, vs comparateurs actifs. Les facteurs permettant de prédire une rémission sur le long terme dans la dépression étaient les suivants : un début de réponse à l’antidépresseur dès la deuxième semaine, une réponse qui se maintient à la huitième semaine et une observance thérapeutique prolongée pendant six mois. En outre, quel que soit le bras de traitement, un traitement prolongé était associé à une amélioration plus marquée de tous les symptômes cliniques. Après six mois de traitement, seuls 15,9 % des patients sous escitalopram avaient interrompu leur traitement contre 23,9 % des patients sous comparateurs poolés (p < 0,001). Cette revue partielle de la littérature montre qu’il est nécessaire de retenir une définition exigeante de la rémission dans la dépression. À cet égard, l’escitalopram, permettant une rémission à la huitième semaine et dont l’acceptation par les patients est très favorable, se révèle un choix des plus pertinents pour un traitement antidépresseur, aussi bien en phase aiguë qu’à long terme. Such a prevalent disease as Major Depressive Disorder (MDD), associated with prominent impairment in physical and social functioning, implies as well an increased morbidity and mortality. Long-term treatments are required due to the frequent occurrence of relapses. Patient compliance is a core factor in both acute and continuation treatment, closely related to tolerability issues. We have partially reviewed the literature published on PubMed since 2004 which assess the relative antidepressant efficacy of escitalopram and comparator antidepressants in adult patients who met DSM-IV criteria for major depressive disorder (MDD). Clinically important differences exist between commonly prescribed antidepressants. These analyses are in favor of a superior efficacy and tolerability of long-term escitalopram treatment (10 to 20 mg/day) compared with active controls, including selective serotonin re-uptake inhibitors (SSRIs) (paroxetine, citalopram, bupropion, fluoxetine, fluvoxamine, sertraline), serotonin/noradrenaline reuptake inhibitors (SNRIs) (venlafaxine, milnacipran and duloxetine) and noradrenergic and specific serotonergic antidepressants (NaSSAs) (mirtazapine). Cipriani et al. (2009) have performed a network meta-analysis of 12 new generation antidepressants. They have shown that clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favor of escitalopram and sertraline in acute treatment, defined as 8-week treatment. Kasper et al. (2009) conducted a post-hoc pooled analysis of data from two 6-month randomized controlled trials that revealed superior efficacy and tolerability of escitalopram when compared with paroxetine. The pooled analysis of four randomized, double-blind, active comparator, 6-month trials in MDD, by Wade et al. (2009), showed that short-term outcomes may predict long-term treatment compliance and outcomes. A higher probability of achieving remission was associated with responding after 8 weeks and with completing 6 months of treatment. Furthermore, Week 24 complete remission (MADRS ≤ 5) was significantly (P < 0,01) higher for escitalopram (51.7%) than for the pooled comparators (45.6%). And after 6 months, fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (P < 0.001). This fragmentary review of the literature shows that it is necessary to adopt a stringent definition of remission in depression, especially in clinical trials; a MADRS total score less or equal to 10 to define remission, a MADRS total score less or equal to 5 to define complete remission, and moreover no MADRS single item greater than 1 to define symptom-free remission. In all these meta-analyses, the superiority of escitalopram compared with other antidepressants was confirmed for both acute and long-term treatment of MDD, especially in harshly depressed patients." @default.
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• W2107173600 date "2012-02-01" @default.
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• W2107173600 title "Efficacité clinique et obtention d’une rémission complète dans la dépression : intérêt de l’escitalopram" @default.
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