Antidepressant Prescriptions Have Not Fully Reflected Evolving Evidence from Cumulative Network Meta-analyses and Guideline Recommendations.
Luo Y., Ostinelli EG., Sahker E., Chaimani A., Kataoka Y., Ogawa Y., Cipriani A., Salanti G., Furukawa TA.
OBJECTIVE: This study compares three major elements of evidence-based medicine (EBM) practices, namely evidence synthesis, clinical practice guidelines (CPGs) and real-world prescriptions in the US, regarding antidepressant treatments of major depression over the past three decades. STUDY DESIGN AND SETTING: We conducted network meta-analyses (NMAs) of antidepressants every 5 years up to 2016 based on a comprehensive dataset of double-blind randomized controlled trials. We identified CPGs and extracted their recommendations. We surveyed the prescriptions in the US at 5-yearly intervals up to 2015. RESULTS: Most drugs recommended by CPGs presented favorable performance in efficacy and acceptability in NMAs. However, CPG recommendations were often in terms of drug classes rather than individual drugs, while NMAs suggested distinctive difference between drugs within the same class. The update intervals of all CPGs were longer than 5 years. All the antidepressants prescribed frequently in the US were recommended by CPGs. However, changes in prescriptions did not correspond to alterations in CPGs nor to apparent changes in the effects indicated by NMAs. Many factors including marketing efforts, regulations or patient values may have played a role. CONCLUSIONS: Enhancements including accelerating CPG updates and monitoring the impact of marketing on prescriptions should be considered in future EBM implementation.