Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence

• Published in: BMJ (Online) 2015-09, Vol.351, p.h4320-h4320
• Main Authors: Le Noury, Joanna, Nardo, John M, Healy, David, Jureidini, Jon, Raven, Melissa, Tufanaru, Catalin, Abi-Jaoude, Elia
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adrenergic Uptake Inhibitors - administration & dosage; Adrenergic Uptake Inhibitors - therapeutic use; Antidepressants; Antidepressive Agents, Second-Generation - administration & dosage; Antidepressive Agents, Second-Generation - therapeutic use; Blister packs; Child & adolescent mental health; Child & adolescent psychiatry; Clinical trials; Correspondence; Data Interpretation, Statistical; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - physiopathology; Depressive Disorder, Major - psychology; Double-Blind Method; Drug overdose; Evidence-Based Medicine; Humans; Imipramine; Imipramine - administration & dosage; Imipramine - therapeutic use; Mental depression; Mental disorders; Methods; Paroxetine; Paroxetine - administration & dosage; Paroxetine - therapeutic use; Patients; Pharmaceutical industry; Placebos; Psychiatric Status Rating Scales; Psychotropic drugs; Randomized Controlled Trials as Topic; Substance abuse treatment; Suicides & suicide attempts; Teenagers; Treatment Outcome
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.h4320

Objectives To reanalyse SmithKline Beecham’s Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. Design Double blind randomised placebo controlled trial. Setting 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. Participants 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. Interventions Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. Main outcome measures The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale; predictors of response; and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. Results The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. Conclusions Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with b