Patient preference effects in a randomized comparative effectiveness study of electroconvulsive therapy and ketamine for treatment resistant depression: An ELEKT-D trial secondary analysis
Abstract
INTRODUCTION
Previous studies have shown patient preference can have large effects on treatment adherence and patient satisfaction. However, the direct effects of matching treatment with patient preference on efficacy and safety outcomes remain unclear. We aimed to evaluate the effects of patient preference and preference-matching on efficacy, adverse events, and adherence to electroconvulsive therapy (ECT) and intravenous (IV) ketamine treatments in a randomized clinical trial.
METHODS
Data were collected during the Patient-Centered Outcomes Research Institute (PCORI) funded ECT vs. Ketamine in Patients with Treatment Resistant Depression (ELEKT-D) study, which randomized patients to treatment with either ECT or IV ketamine across five U.S. sites. We performed post hoc-analyses on 255 patients who provided responses to a patient preference survey following treatment phase completion, which allowed us to explore the relationships between treatment preference and several treatment outcome measures.
RESULTS
Our analysis showed that (1) Ketamine was preferred by more trial participants than ECT; (2) Preference for ketamine was associated with higher likelihood of treatment response for all patients regardless of treatment assignment; (3) Preference-matching (patients receiving the treatment they indicated a moderate or strong preference for on the survey) was associated with greater likelihood of treatment response to ketamine but not ECT; (4) Preference-matching was associated…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 255 participants or records.
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