Vortioxetine Versus First-Line Antidepressants In The Treatment Of Major Depressive Disorder:A Network Meta-Analysis

Objective: To compare the efficacy,tolerability and safety of vortioxetine and first-line antidepressants in the treatment of major depressive disorder(MDD)by network Meta-analysis.Methods: Embase,Cochrane Library,Pub Med,Wanfang Data Knowledge Service Platform,VIP database,China National Knowledge Infrastructure(CNKI),and China Biology Medicine Disc were searched by computer from the database construction to December 2022.Two researchers independently screened the literature based on the inclusion and exclusion criteria,evaluated the quality of the literature and extracted the data.ADDIS 1.16.5 software was used for network Meta-analysis.Results: There were 20 articles in this study,including randomized controlled trials of votioxetine and first-line antidepressants in the treatment of major depressive disorder,involving eight drugs(votioxetine,sertraline,paroxetine,fluoxetine,escitalopram,citalopram,duloxetine,Venlafaxine).Primary outcomes were response rate and adverse event rate,secondary outcomes were cure rate and drop-out rate for any reason.The results of the mesh meta-analysis were as follows:1.Response rate: Duloxetine and paroxetine were better than placebo with statistical significance(P<0.05).According to the ranking of results by Bayesian statistical method,the probability that each drug may be the best therapeutic measure is:aroxetine(P=0.45)> sertraline(P=0.25)> duloxetine(P=0.18)> nlafaxine(P=0.05)> citalopram(P=0.02)= escitalopram(P=0.02)> vortioxetine(P=0.01)= fluoxetine(P=0.01)> placebo(P=0.00).2.Cure rate: Duloxetine and paroxetine were better than placebo,which the differences were statistically significant(P<0.05).According to the ranking of results by Bayesian statistical method,the probability that each drug may be the best therapeutic measure is: Paroxetine(P=0.48)>duloxetine(P=0.21)> venlafaxine(P=0.12)> sertraline(P=0.10)>vortioxetine(P=0.03)= citalopram(P=0.03)> fluoxetine(P=0.02)>escitalopram(P=0.01)> placebo(P=0.00).3.The incidence of adverse events: citalopram,duloxetine,escitalopram,paroxetine,sertraline,venlafaxine was higher than placebo,and sertraline was higher than votioxetine with statistically significant differences(P<0.05).According to the Bayesian statistical method,the probability that each drug is likely to have the highest incidence of adverse events is ranked as follows:Citalopram(P=0.56)> sertraline(P=0.31)> paroxetine(P=0.04)>duloxetine(P=0.03)= escitalopram(P=0.03)> fluoxetine(P=0.02)=venlafaxine(P=0.02)> vortioxetine(P=0.00)= placebo(P=0.00).4.The dropout rate of escitalopram was significantly higher than that of placebo(P<0.05).According to the Bayesian statistical method,the probability ranking of each drug with the highest dropout rate is as follows: Escitalopram(P=0.77)> citalopram(P=0.07)> vortioxetine(P=0.06)> sertralin(P=0.03)= venlafaxine(P=0.03)> fluoxetine(P=0.02)= duloxetine(P=0.02)> paroxetine(P=0.01)> placebo(P=0.00).Conclusion:1.Paroxetine,duloxetine,sertraline and venlafaxine were more effective than citalopram,vortioxetine,escitalopram and fluoxetine,among which paroxetine was the strongest;2.Vortioxetine had the highest safety compared with 7 first-line antidepressants;3.Vortioxetine has different advantages and disadvantages compared with 7 first-line antidepressants.