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Cutoff Scores as Measures for Treatment Outcome

Response Criteria

In a meta-analysis of short-term (4 weeks) trials with antidepressants, two response criteria were compared separately for low- (< 22), medium- (22-27) and high- (> 27) HAMD-17 score groups: (1) 50% reduction of HAMD-17 baseline score; and (2) 50% reduction of HAMD-17 baseline score plus HAMD-17 cutoff score < 10. The study was based on a large sample comprising a total of 2'793 patients of whom n=619 received imipramine, n=1836 moclobemide, and n=338 placebo (data provided by courtesy Hoffmann-La Roche, Basle).

Uniform Decrease of Baseline Scores

Our analysis showed that, on average, the HAMD-17 scores decreased uniformly in all three groups, independently of the initial severity at baseline. The relative score differences between high-scorers, medium-scorers and low-scorers remained virtually unchanged over the entire observation period. Furthermore, the more stringent criterion, combining a 50% baseline score reduction with a cutoff score < 10, implied a clear disadvantage to high-scorers to become responders, since cases with severe depression at baseline required much more time to reach this threshold than mild or moderately severe cases.

Drug-Placebo Differences

As to the question of evaluating differences between placebo and drugs, our analyses demonstrated that the simple response criterion of 50% HAMD-17 baseline score reduction was better suited to discriminate between placebo-responders and drug-responders in acute clinical trials.

References

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score reduction
Fig. 8: Time course of recovery from depression under imipramine. The relative score differences between high-scorers, medium-scorers and low-scorers are virtually identical over the entire observation period (differences between medium- and low-scorers reduce when close to a HAMD-17 score of 10).
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