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Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder : Personalizing the treatment choice using individual participant data network metaregression

Published on Jan 1, 2018in Psychotherapy and Psychosomatics 13.74
· DOI :10.1159/000489227
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University),
Orestis Efthimiou12
Estimated H-index: 12
(University of Bern)
+ 8 AuthorsElisabeth Schramm26
Estimated H-index: 26
(University of Freiburg)
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Abstract
BACKGROUND: Persistent depressive disorder is prevalent, disabling, and often difficult to treat. The cognitive-behavioral analysis system of psychotherapy (CBASP) is the only psychotherapy specifically developed for its treatment. However, we do not know which of CBASP, antidepressant pharmacotherapy, or their combination is the most efficacious and for which types of patients. This study aims to present personalized prediction models to facilitate shared decision-making in treatment choices to match patients' characteristics and preferences based on individual participant data network metaregression. METHODS: We conducted a comprehensive search for randomized controlled trials comparing any two of CBASP, pharmacotherapy, or their combination and sought individual participant data from identified trials. The primary outcomes were reduction in depressive symptom severity for efficacy and dropouts due to any reason for treatment acceptability. RESULTS: All 3 identified studies (1,036 participants) were included in the present analyses. On average, the combination therapy showed significant superiority over both monotherapies in terms of efficacy and acceptability, while the latter 2 treatments showed essentially similar results. Baseline depression, anxiety, prior pharmacotherapy, age, and depression subtypes moderated their relative efficacy, which indicated that for certain subgroups of patients either drug therapy or CBASP alone was a recommendable treatment option that is less costly, may have fewer adverse effects and match an individual patient's preferences. An interactive web app (https://kokoro.med.kyoto-u.ac.jp/CBASP/prediction/) shows the predicted disease course for all possible combinations of patient characteristics. CONCLUSIONS: Individual participant data network metaregression enables treatment recommendations based on individual patient characteristics. © 2018 S. Karger AG, Basel. KEYWORDS: Cognitive-behavioral analysis system of psychotherapy; Persistent depressive disorder; Pharmacotherapy
  • References (62)
  • Citations (7)
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References62
Newest
Published on May 1, 2018in Statistical Methods in Medical Research 2.39
Thomas P. A. Debray19
Estimated H-index: 19
(UU: Utrecht University),
Ewoud Schuit17
Estimated H-index: 17
(Stanford University)
+ 4 AuthorsKarel G. M. Moons77
Estimated H-index: 77
(UU: Utrecht University)
Network meta-analysis (NMA) is a common approach to summarizing relative treatment effects from randomized trials with different treatment comparisons. Most NMAs are based on published aggregate data (AD) and have limited possibilities for investigating the extent of network consistency and between-study heterogeneity. Given that individual participant data (IPD) are considered the gold standard in evidence synthesis, we explored statistical methods for IPD-NMA and investigated their potential a...
Published on Nov 1, 2017in The Lancet Psychiatry 18.33
Myrto Samara15
Estimated H-index: 15
(A.U.Th.: Aristotle University of Thessaloniki),
Yair Goldberg9
Estimated H-index: 9
(University of Haifa)
+ 5 AuthorsStefan Leucht71
Estimated H-index: 71
(TUM: Technische Universität München)
Summary Background The efficacy of antipsychotics across the initial severity range in patients with acute mania remains unclear. Therefore, we examined the influence of baseline severity on the efficacy of olanzapine. Methods We did an individual participant data meta-analysis of double-blind, randomised controlled trials that compared olanzapine with placebo, identified through searches of the ClinicalStudyRequest.com database on Feb 2, 2016. We included patients with acute mania associated wi...
Published on Nov 1, 2017in The American Journal of Medicine 4.76
Ralph I. Horwitz5
Estimated H-index: 5
(TU: Temple University),
Allison Hayes-Conroy8
Estimated H-index: 8
(TU: Temple University)
+ 1 AuthorsBurton H. Singer75
Estimated H-index: 75
(UF: University of Florida)
Abstract Evidence based medicine, using randomized controlled trials and meta-analyses as the major tools and sources of evidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guide to decision-making about a patient at hand. However, these tools do not answer the clinician's question: "Will a given therapeutic regimen help my patie...
Published on Jun 29, 2017in Cochrane Database of Systematic Reviews 7.75
Sarah J Nolan13
Estimated H-index: 13
(University of Liverpool),
Maria Sudell4
Estimated H-index: 4
(University of Liverpool)
+ 2 AuthorsAnthony G Marson43
Estimated H-index: 43
(University of Liverpool)
Background Epilepsy is a common neurological condition with a worldwide prevalence of around 1%. Approximately 60% to 70% of people with epilepsy will achieve a longer-term remission from seizures, and most achieve that remission shortly after starting antiepileptic drug treatment. Most people with epilepsy are treated with a single antiepileptic drug (monotherapy) and current guidelines from the National Institute for Health and Care Excellence (NICE) in the United Kingdom for adults and childr...
Published on Apr 15, 2017in Statistics in Medicine 1.85
Orestis Efthimiou12
Estimated H-index: 12
(UoI: University of Ioannina),
Dimitris Mavridis22
Estimated H-index: 22
(UoI: University of Ioannina)
+ 5 AuthorsGeorgia Salanti52
Estimated H-index: 52
(UoI: University of Ioannina)
Non-randomized studies aim to reveal whether or not interventions are effective in real-life clinical practice, and there is a growing interest in including such evidence in the decision-making process. We evaluate existing methodologies and present new approaches to using non-randomized evidence in a network meta-analysis of randomized controlled trials (RCTs) when the aim is to assess relative treatment effects. We first discuss how to assess compatibility between the two types of evidence. We...
Published on Apr 5, 2017in BMJ 27.60
Sarah J Nolan13
Estimated H-index: 13
(University of Liverpool),
Anthony G Marson43
Estimated H-index: 43
(University of Liverpool)
+ 3 AuthorsCatrin Tudur-Smith26
Estimated H-index: 26
(University of Liverpool)
Abstract Objective To investigate whether the success rate of retrieving individual participant data (IPD) for use in IPD meta-analyses has increased over time, and to explore the characteristics associated with IPD retrieval. Design Systematic review of published IPD meta-analyses, supplemented by a reflection of the Cochrane Epilepsy Group’s 20 years’ experience of requesting IPD. Data sources Medline, CENTRAL, Scopus, Web of Science, CINAHL Plus, and PsycINFO. Eligibility criteria for study s...
Published on Mar 1, 2017in British Journal of Psychiatry 7.23
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University),
Erica Weitz10
Estimated H-index: 10
+ 12 AuthorsUlrich Hegerl57
Estimated H-index: 57
(Leipzig University)
Background The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo. Aims To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method A systematic review and a...
Published on Mar 1, 2017in JAMA Psychiatry 15.92
Elisabeth Schramm26
Estimated H-index: 26
(University of Freiburg),
Levente Kriston28
Estimated H-index: 28
(UHH: University of Hamburg)
+ 13 AuthorsAntje Gumz8
Estimated H-index: 8
(UHH: University of Hamburg)
Importance Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy. Objective To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP). Design, Setting, and Participants A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset ...
Published on Feb 1, 2017in Journal of Clinical Epidemiology 4.65
Maria Petropoulou4
Estimated H-index: 4
(UoI: University of Ioannina),
Adriani Nikolakopoulou11
Estimated H-index: 11
(University of Bern)
+ 9 AuthorsAnna Chaimani20
Estimated H-index: 20
(UoI: University of Ioannina)
Abstract Objectives To assess the characteristics and core statistical methodology specific to network meta-analyses (NMAs) in clinical research articles. Study Design and Setting We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception until April 14, 2015, for NMAs of randomized controlled trials including at least four different interventions. Two reviewers independently screened potential studies, whereas data abstraction was performed by a single reviewer ...
Published on Feb 1, 2017in Epidemiology and Psychiatric Sciences 6.40
Ronald C. Kessler229
Estimated H-index: 229
(Harvard University),
H. M. van Loo4
Estimated H-index: 4
+ 10 AuthorsNancy A. Sampson66
Estimated H-index: 66
(Harvard University)
Backgrounds. Clinicians need guidance to address the heterogeneity of treatment responses of patients with major depressive disorder (MDD). While prediction schemes based on symptom clustering and biomarkers have so far not yielded results of sufficient strength to inform clinical decision-making, prediction schemes based on big data predictive analytic models might be more practically useful. Method. We review evidence suggesting that prediction equations based on symptoms and other easily- ass...
Cited By7
Newest
Published on Sep 1, 2019in Behaviour Research and Therapy 4.31
Wolfgang Lutz40
Estimated H-index: 40
(University of Trier),
Julian A. Rubel12
Estimated H-index: 12
(University of Trier)
+ 2 AuthorsAnne-Katharina Deisenhofer3
Estimated H-index: 3
(University of Trier)
Abstract In this study, a computer-based feedback, decision and clinical problem-solving system for clinical practice will be described - the Trier Treatment Navigator (TTN). The paper deals with the underlying research concepts related to personalized pre-treatment recommendations for drop-out risk and optimal treatment strategy selection as well as personalized adaptive recommendations during treatment. The development sample consisted of 1234 patients treated with cognitive behavioral therapy...
Published on Jun 1, 2019in BMJ Open 2.38
Eirini Karyotaki13
Estimated H-index: 13
(VU: VU University Amsterdam),
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University)
+ 2 AuthorsPim Cuijpers99
Estimated H-index: 99
(VU: VU University Amsterdam)
Introduction Although guided forms of internet-based cognitive-behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is unclear which types of patients may benefit more from each of these two forms of iCBT. Network meta-analysis (NMA) using individual participant data (IPD) offers a way to assess the ...
Published on May 1, 2019in Journal of Affective Disorders 4.08
Hisashi Noma14
Estimated H-index: 14
,
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University)
+ 6 AuthorsAndrea Cipriani43
Estimated H-index: 43
(University of Oxford)
Abstract Background It is clinically important to know who are likely to respond more or less to antidepressants. However, meaningful effect modifiers (variables associated with differential response depending on the treatment) are yet to be identified. Methods We conducted individual participant data (IPD) meta-analysis and meta-regression to explore effect modifiers in placebo-controlled antidepressant trials conducted so far in Japan. Results We obtained access to IPD from seven placebo-contr...
Published on Mar 14, 2019in Epidemiology and Psychiatric Sciences 6.40
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University),
Mirjam Reijnders3
Estimated H-index: 3
+ 17 AuthorsRobin B. Jarrett33
Estimated H-index: 33
(UTSW: University of Texas Southwestern Medical Center)
AimsThe Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale.MethodsWe obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified c...
Published on Feb 1, 2019in Evidence-based Mental Health
Andrea Cipriani43
Estimated H-index: 43
,
Anneka Tomlinson1
Estimated H-index: 1
With 350 million people affected in the world, depressive disorder is one of the top 20 causes of the overall global burden of disease.1 The high costs, both direct and indirect, of major depressive disorder are largely due to the significant deficits in treatment provision2 and therefore remediable with current therapies. A key international challenge is to determine how best to implement currently available and effective treatments. There are a number of efficacious pharmacological and non-pha...
Samuele Cortese49
Estimated H-index: 49
(University of Southampton),
Anneka Tomlinson1
Estimated H-index: 1
(University of Oxford),
Andrea Cipriani43
Estimated H-index: 43
(Oxford Health NHS Foundation Trust)
Objective Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality. Method PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was apprais...
Published on Jan 1, 2019
Shashikanta Tarai1
Estimated H-index: 1
(NITRR: National Institute of Technology, Raipur)
Sina A. Clausen , Wolfgang Lutz29
Estimated H-index: 29
,
Wolfgang Lutz40
Estimated H-index: 40
Aus den Diskussionen der letzten Jahre zu den Psychotherapierichtlinien, der Reform der Psychotherapieaus- und -weiterbildung sowie zu evaluativen und qualitatssichernden Masnahmen in der Praxis ergab sich bereits der positive Effekt einer starkeren Beteiligung vieler Psychotherapeutinnen und Psychotherapeuten an praxisbezogenen Forschungs- und Evaluationsbemuhungen 1 . Das in Grosbritannien im gesamten Gesundheitssystem eingesetzte Konzept des Improving Access to Psychological Therapies (IAPT) ...
Published on Nov 1, 2018in BMJ Open 2.38
Toshi A. Furukawa42
Estimated H-index: 42
(Kyoto University),
Eirini Karyotaki13
Estimated H-index: 13
(VU: VU University Amsterdam)
+ 5 AuthorsOrestis Efthimiou12
Estimated H-index: 12
(University of Bern)
Introduction Psychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient’s characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of patients may benefit more from different components or their combinations. Methods and analysis Internet-delivered cognitive–behavioural therapy (iCBT...