À compter du 1er décembre 2023, l’accès à POEMs et à Essential Evidence Plus ne fera plus partie des avantages offerts aux membres de l’AMC.
Question clinique
Does continuing olanzapine (Zyprexa) plus sertraline versus sertraline alone reduce the risk of relapse in adults with psychotic depression in remission?
L’Essentiel
Continuing olanzapine plus sertraline instead of sertraline alone for 36 weeks significantly reduced the risk of relapse in adults with psychotic depression in remission. Continuing olanzapine was associated with weight gain. 1b-
Référence
Plan de l'etude: Randomized controlled trial (single-blinded)
Financement: Industry + govt
Cadre: Outpatient (specialty)
Sommaire
Treating psychotic depression includes both an antidepressant and antipsychotic medication. However, it remains uncertain as to whether outcomes are improved by continuing both medications after patients are in remission. These investigators identified patients, aged 18 to 85 years, meeting standard diagnostic criteria for major depression with associated delusions. Study participants (n = 269) initially received sertraline (target dose, 150-200 mg/d) plus olanzapine (target dose, 15-20 mg/d) for up to 12 weeks. Those patients (n = 126) meeting criteria for stable remission or near remission (rated as very much improved) for 8 weeks randomly received (concealed allocation assignment) either continued sertraline and olanzapine or sertraline and placebo. Follow-up occurred for all participants at 36 weeks, with 90.5% of randomized participants completing the trial. Individuals assessing outcomes remained masked to treatment group assignment. Using intention-to-treat analysis, Relapse occurred in significantly fewer patients in the sertraline-olanzapine group compared to the sertraline-placebo group (20.3% vs 54.8%, NNT= 2.9; 95% CI, 2.1-5.6). Adverse effects mainly including weight gain occurred more often in the sertraline-olanzapine group (17.2% vs 4.8%). The incidence of akathisia and tardive dyskinesia was similar in both groups.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
Adverse metabolic effects of olanzapine
Thirty-six weeks is a good observation period but a longer therapeutic interval, like a couple of years, might be a different consideration because of the metabolic adverse effects of olanzapine.