Anti-inflammatory pharmacotherapy for depressive disorders: A network meta-analysis of double-blind, randomised, controlled, parallel-group clinical trials
Abstract
Background: Neuroinflammation has emerged as a potential biological mechanism underlying depressive disorders and represents an increasingly investigated target for therapeutic intervention.
Objective: To compare the effects of pharmacological interventions evaluated within an inflammation-related framework on depressive symptom severity and inflammatory biomarker outcomes.
Methods: Randomised controlled trials reporting pharmacological interventions for depressive disorders were included. A frequentist fixed-effects network meta-analysis was conducted for depressive symptom severity at the end of randomised treatment. Treatments were ranked using surface under the cumulative ranking curve values. Exploratory pairwise meta-analyses were performed separately for tumour necrosis factor-alpha, interleukin-6, interferon-gamma, C-reactive protein, and interleukin-2.
Results: Eleven randomised controlled trial reports contributed to a sparse network of 10 active interventions. Using a frequentist fixed-effect network meta-analysis, escitalopram oxalate showed the largest estimated reduction in depressive symptom severity relative to the reference control node (mean difference [MD]: −13.03; 95% confidence interval [CI]: −24.54 to −1.52). Ketamine 0.5 mg/kg (MD: −5.16; 95% CI: −8.81 to −1.51) and selective serotonin reuptake inhibitor plus glycyrrhizic acid (MD: −4.35; 95% CI: −7.16 to −1.55) also showed estimates favouring intervention. Fluoxetine, fluoxetine plus triiodothyronine,…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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