Net Meta-analysis Of The Efficacy And Safety Of Agomelatine And SSRIs In The Treatment Of Major Depression

Objective: To evaluate the efficacy and safety of agomelatin and SSRIs in the treatment of depression by Network meta-analysis.Methods: China National Knowledge Network（CNKI）,Wanfang Data Knowledge Service Platform,VIP database,CBM,Pub Med,Embase and Cochrane Library were searched from the database establishment to November 2021.Two researchers independently screened the retrieved literature according to the inclusion criteria,and carried out quality evaluation and data extraction.Included studies included randomized controlled trials comparing agomelatine with SSRIs in the treatment of major depression with placebo controls and drugs directly.ADDIS software was used for statistical analysis.The primary outcome was response rate and the percentage of patients with adverse events,while the secondary outcome was the cure rate and the number of patients who dropped out of the study for any event.Results:1.Network meta-analysis showed that in terms of treatment res ponse,Results of Network meta-analysis showed that agomelatine{OR=1.84,95%CI（1.36,2.52）},escitopram {OR=2.27,95%CI（1.50,3.42）},paroxetine {OR=1.74,95%CI（1.03,2.91）} was superior to placeb o.The difference was statistically significant,while there was no s ignificant difference between the other interventions.According to The Bayesian statistical analysis,the possible best therapeutic measu res in terms of effective rate were escitalopram（0.63）> paroxetine（0.15）> agomelatine（0.08）> citalopram（0.06）> sertraline（0.04）= fluoxetine（0.04）> placebo（0.00）.2.In terms of cure rate,the results of Network meta-analysis showed that there was no significant pairwise difference among all interventions in terms of cure rate.The results were ranked according to The Statistical method of Bayesian.In terms of cure rate,the order of intervention that might be the best treatment was paroxetine（0.31）>sertraline（0.27）> escitalopram（0.16）> agomelatine（0.13）> fluoxetine（0.12）> placebo（0.00）= citalopram（0.00）.3.In terms of the incidence of adverse events,Network meta-analysis showed that paroxetine {OR=1.50,95%CI（1.05,2.21）}was higher than placebo in terms of the incidence of adverse events,and the difference was statistically significant.There was no significant difference between the other intervention measures.Using bayesian statistical methods to sort the results,The probability of each intervention becoming the treatment with the highest incidence of adverse events was ranked as paroxetine（0.44）> sertraline（0.40）> citalopram（0.10）>fluoxetine（0.03）=escitalopram（0.03）> Agomelatine（0.00）>=placebo（0.00）.4.In terms of the number of patients dropping out of the study for any reason,Network meta-analysis results showed agomelatine { OR =0.51,95% CI（0.33,0.81）},paroxetine {OR = 0.49,95% CI（0.25,0.94）},fluoxetine {OR = 0.50,95% CI（0.30,0.86）},escitalopram citalopram{OR = 0.55,95%CI（0.34,0.88）} was lower than sertraline,and the difference was statistically significant,while there was no significant difference between other interventions.Using bayesian statistical methods to sort the results,The probability of each intervention being the treatment with the largest number of patients dropping out of the study was ranked as sertraline（0.74）> citalopram（0.24）> placebo（0.02）>paroxetine（0.01）> fluoxetine（0.00）= Agomelatine（0.00）=escitalopram（0.00）.Conclusion : Escitalopram and paroxetine were superior to sertraline,agomelatine,citalopram and fluoxetine inefficacy.In terms of safety,agomelatine and escitalopram are superior to citalopram,fluoxetine,sertraline and paroxetine.