Anti-Inflammatory Treatment Efficacy in Major Depressive Disorder: A Systematic Review of Meta-Analyses

Publikation: Beitrag in FachzeitschriftÜbersichtsartikel (Review)BeigetragenBegutachtung

Beitragende

  • Maria S Simon - , Dresden International University (Autor:in)
  • Gara Arteaga-Henríquez - , Vall d'Hebron Research Institute (VHIR) (Autor:in)
  • Ahmed Fouad Algendy - , Dresden International University (Autor:in)
  • Timo Siepmann - , Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • Ben M W Illigens - , Dresden International University (Autor:in)

Abstract

PURPOSE: Immune imbalances in major depressive disorder (MDD) have been targeted by anti-inflammatory treatment approaches in clinical trials to increase responsiveness to therapy. However, even after several meta-analyses, no translation of evidence into clinical practice has taken place. We performed a systematic review to evaluate meta-analytic evidence of randomized controlled trials on the use of anti-inflammatory agents for MDD to summarize efficacy estimates and elucidate shortcomings.

METHODS: Pooled effect estimates and heterogeneity indices were primary outcomes. Characteristics of the included meta-analyses were extracted. Scientific quality of meta-analyses was assessed using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR).

RESULTS: N=20 meta-analyses met the eligibility criteria. Study characteristics like outcome scales, composition of patient populations, and add-on or monotherapy regimen varied very little for celecoxib studies, varied little for minocycline studies, and were rather variable for omega 3 fatty acids studies. R-AMSTAR scores ranged from 26 to 39 out of 44 points indicating variable quality, where a comprehensive literature search was the strongest and the consideration of scientific quality in the conclusions was the weakest domain across all meta-analyses. For minocycline and celecoxib, superiority was demonstrated with medium to large effect size with substantial heterogeneity and with large to very large effect size with negligible heterogeneity, respectively. For omega 3 fatty acids, superiority was also demonstrated with mainly small and medium effect sizes with substantial heterogeneity. However, for minocycline and omega 3 fatty acids, non-significant meta-analyses were found also.

CONCLUSION: Even in our synthesized approach, no clear recommendations could be derived on the use of anti-inflammatory treatment for MDD due to several critical aspects like heterogeneity, diversity of patient populations, treatment regimen, and outcomes, and limited scientific quality. However, we observed clear inter-substance differences with meta-analytic evidence being strongest for celecoxib and weakest for omega 3 fatty acids.

Details

OriginalspracheEnglisch
Seiten (von - bis)1-25
Seitenumfang25
FachzeitschriftNeuropsychiatric disease and treatment
Jahrgang19
PublikationsstatusVeröffentlicht - 2023
Peer-Review-StatusJa

Externe IDs

PubMedCentral PMC9830720
Scopus 85146181467

Schlagworte