Comparison Of Efficacy And Safety Of Agomelatine And SSRIs In Depression:a Systematic Review And Meta-analysis

Background:Selective serotonin reuptake inhibitors(SSRIs) is commonly used drugs for the treatment of depression, and is recognized as the first-line drugs. These drugs include sertraline, paroxetine, fluoxetine, fluvoxamine,citalopram and escitalopram. Agomelatine is a new antidepressant listed in2009, which belongs to the melatonin receptor agonist and 5-HT2 C receptor antagonist and has an effect on both anxiety and depression. Studies on comparison of the efficacy and safety between agomelatine and SSRIs are different.Objective: To compare efficacy and safety between agomelatine and SSRIs(sertraline, paroxetine, fluoxetine, fluvoxamine, escitalopram) in the treatment of depression.Method: Retrieve literatures in database at home and abroad,which are about the randomized controlled trials of agomelatine and SSRIs(sertraline,fluoxetine, fluvoxamine, paroxetine and citalopram or escitalopram) in the treatment of depression. According to inclusion criteria and exclusion criteria,choose relative articles to make a systematic review and meta-analysis. Two foreign databases and five Chinese database included Pub Med, Cochrane Library,Chinese knowledge resources database(CNKI), Chinese science and technology periodical database, Wanfang Data retrieval system and the Chinesebiomedical literature service system. Statistical analysis was carried out by Review manager 5.3.5 software.Results: A total of sixty eight English literatures and nineteen Chinese literatures were retrieved. And other four studies were find from the other literatures. Finally, Twelve English literatures and three Chinese literatures were adopted. The effect of agomelatine had no significant differences compared with SSRIs(RR:1.01, 95%CI:[0.96, 1.06], P=0.78). And the same to sertraline(RR:1.08, 95%CI:[0.94, 1.25], P=0.25), paroxetine(RR:0.94,95%CI:[0.84, 1.04], P=0.22), fluoxetine(RR:1.01, 95%CI:[0.94, 1.09], P=0.78)and escitalopram(RR:1.07, 95%CI: [0.96, 1.18], P=0.21). There was no significant differences in remission rate between them(RR:0.80, 95%CI:[0.63,1.03], P=0.08). The result of the comparison of adverse reactions of agomelatine and SSRIs shows that agomelatine had a lower risk than paroxetine in insomnia(RR:0.40, 95%CI:[0.17, 0.92], P=0.03) and sexual dysfunction(RR:0.13, 95%CI:[0.04, 0.39], P=0.003),than fluoxetine(RR:0.68,95%CI:[0.48, 0.96], P=0.03) and paroxetine(RR:0.37, 95%CI:[0.25, 0.55],P<0.00001) in nausea and vomiting. At the same time it had a lower risk than escitalopram in sweating(RR:0.34, 95%CI:[0.13, 0.85], P=0.002) and headaches(RR:0.63, 95%CI:[0.43, 0.91], P=0.01). The differences of them were significant. Agomelatine had a higher risk than sertraline in drowsiness(RR:4.65, 95%CI:[1.02, 21.16], P=0.05), and than escitalopram in constipation(RR:3.46, 95%CI:[1.16, 10.36], P=0.03), the difference was statistically significant. Compared agomelatine and SSRIs, the occurrence risk of dry mouth and diarrhea had no significant difference.Conclusion: At present, the evidence show that the overall effect of agomelatine is equivalent compared with SSRIs. The tolerance of agomelatine is better than escitalopram. The safety of agomelatine and SSRIs both have their own advantages and disadvantages.