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Regarding “Comprehensive Analysis of Remission (COMPARE) with Venlafaxine Versus SSRIs”

      Nemeroff et al. (
      • Nemeroff C.B.
      • Entsuah R.
      • Benattia I.
      • Demitrack M.
      • Sloan D.M.
      • Thase M.E.
      Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs.
      ) present a comprehensive meta-analysis of venlafaxine versus selective serotonin reuptake inhibitor (SSRI) in the treatment of major depression and address the important question of whether there are differences in efficacy between newer antidepressants. The authors show a small but significant advantage of venlafaxine over fluoxetine in achieving remission. They report, compared with all SSRIs, a number needed to treat (NNT) of 17, which would be of public health relevance. In a recent review (
      • Weinmann S.
      • Becker T.
      • Koesters M.
      Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: Meta-analysis.
      ) based on published studies with more rigorous and restrictive inclusion criteria, we could not show a statistically significant advantage of venlafaxine versus SSRIs in remission rates but found only a small advantage in response rates. Both reviews have in common that if there are any differences in the efficacy of venlafaxine and SSRIs these differences are small. Furthermore, both reviews indicate that venlafaxine seems to be less well-tolerated.
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      References

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        • Entsuah R.
        • Benattia I.
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        • Thase M.E.
        Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs.
        Biol Psychiatry. 2008; 63: 424-434
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        Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: Meta-analysis.
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        Biological PsychiatryVol. 66Issue 5
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          We appreciate the thoughtful comments of Koesters et al. (1). We were of course aware of their meta-analysis, which focused on a subset of the published studies comparing venlafaxine and various selective serotonin reuptake inhibitors (SSRIs) and regret that their report was not published in time to be available for discussion in our article. With respect to the first point raised by Koesters et al., we agree that the differences between the results of their meta-analysis and ours are small. We also agree that publication bias can distort the results of meta-analyses; this is why we included all randomized double blind trials comparing venlafaxine and SSRIs in major depressive disorder conducted by Wyeth before 2007, whether published or not.
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