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

T.A. Furukawa; O. Efthimiou; E.S. Weitz; A. Cipriani; M.B. Keller; J.H. Kocsis; D.N. Klein; J. Michalak; G. Salanti; P. Cuijpers; E. Schramm

doi:10.1159/000489227

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

T.A. Furukawa, O. Efthimiou, E.S. Weitz, A. Cipriani, M.B. Keller, J.H. Kocsis, D.N. Klein, J. Michalak, G. Salanti, P. Cuijpers, E. Schramm

Research output: Contribution to Journal › Article › Academic › peer-review

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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

Original language	English
Pages (from-to)	140-153
Number of pages	14
Journal	Psychotherapy and Psychosomatics
Volume	87
Issue number	3
Early online date	30 May 2018
DOIs	https://doi.org/10.1159/000489227
Publication status	Published - Jun 2018

Funding

This study has been supported in part by JSPS KAKENHI (Grant-in-Aid for Scientific Research) Grant No. 26670314 and 17K19808, and Comprehensive Research on Disability (Grant No. 17dk0307072) from the Japan Agency for Medical Research and Development to T.A.F. G.S. is a Marie Skłodowska-Curie fellow (MSCA-IF-703254). T.A.F. has received lecture fees from Eli Lilly, Janssen, Meiji, Mitsubishi-Tanabe, MSD, and Pfizer. He has received grant or research support from Mitsubishi-Tanabe and Mochida. J.H.K. has received research grants and contracts from AHRQ, NIMH, Burroughs Wellcome Trust, Pritzker Consortium, Rockefeller Treatment Development Fund, and Elan. He has a patent No. 8,853,279 “Method for Determining Sensitivity or Resistance to Compounds That Activate the Brain Serotonin System.” E.S. received book royalties and honoraria for workshops and presentations relating to CBASP. P.C. received grants from the European Union, ZonMw, and PFGV, and he receives expense allowances for his membership of the board of directors of the Dutch Foundation for Mental Health (Fonds Psychische Gezondheid) and a national telephone helpline (called “Korrelatie”) and for serving as chair of the Science Committee of the Council for Care and Research (RZO) of the Dutch Ministry of Defense. All the other authors report no competing interests to declare.

Funders	Funder number
Council for Care and Research
Dutch Foundation for Mental Health
Dutch Ministry of Defense
RZO
Rockefeller Treatment Development Fund
National Institute of Mental Health
Agency for Healthcare Research and Quality
Burroughs Wellcome Fund
Japan Agency for Medical Research and Development
H2020 Marie Skłodowska-Curie Actions	MSCA-IF-703254
European Commission
Japan Society for the Promotion of Science	17dk0307072, 26670314, 17K19808
ZonMw

Keywords

Cognitive-behavioral analysis system of psychotherapy
Persistent depressive disorder
Pharmacotherapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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CognitiveBehavioral Analysis System of Psychotherapy Drug or Their Combination for Persistent Depressive DisorderFinal published version, 2.03 MBLicence: Article 25fa Dutch Copyright Act

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Supplementary Material for: Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression
Furukawa, T. A. (Contributor), Efthimiou, O. (Contributor), Weitz, E. S. (Contributor), Cipriani, A. (Contributor), Keller, M. B. (Contributor), Kocsis, J. H. (Contributor), Klein, D. N. (Contributor), Michalak, J. (Contributor), Salanti, G. (Contributor), Cuijpers, P. (Contributor) & Schramm, E. (Contributor), Unknown Publisher, 1 Jun 2018
DOI: 10.6084/m9.figshare.6391226.v2, https://karger.figshare.com/articles/Supplementary_Material_for_Cognitive-Behavioral_Analysis_System_of_Psychotherapy_Drug_or_Their_Combination_for_Persistent_Depressive_Disorder_Personalizing_the_Treatment_Choice_Using_Individual_Participant_Data_Network_Metaregression/6391226/2
Dataset / Software: Dataset
Supplementary Material for: Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression
Furukawa, T. A. (Contributor), Efthimiou, O. (Contributor), Weitz, E. S. (Contributor), Cipriani, A. (Contributor), Keller, M. B. (Contributor), Kocsis, J. H. (Contributor), Klein, D. N. (Contributor), Michalak, J. (Contributor), Salanti, G. (Contributor), Cuijpers, P. (Contributor) & Schramm, E. (Contributor), Unknown Publisher, 1 Jun 2018
DOI: 10.6084/m9.figshare.6391226.v1, https://karger.figshare.com/articles/Supplementary_Material_for_Cognitive-Behavioral_Analysis_System_of_Psychotherapy_Drug_or_Their_Combination_for_Persistent_Depressive_Disorder_Personalizing_the_Treatment_Choice_Using_Individual_Participant_Data_Network_Metaregression/6391226/1
Dataset / Software: Dataset

Cite this

Furukawa, T. A., Efthimiou, O., Weitz, E. S., Cipriani, A., Keller, M. B., Kocsis, J. H., Klein, D. N., Michalak, J., Salanti, G., Cuijpers, P., & Schramm, E. (2018). Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: Personalizing the treatment choice using individual participant data network metaregression. Psychotherapy and Psychosomatics, 87(3), 140-153. https://doi.org/10.1159/000489227

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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.{\textcopyright} 2018 S. Karger AG, Basel.KEYWORDS: Cognitive-behavioral analysis system of psychotherapy; Persistent depressive disorder; Pharmacotherapy",

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author = "T.A. Furukawa and O. Efthimiou and E.S. Weitz and A. Cipriani and M.B. Keller and J.H. Kocsis and D.N. Klein and J. Michalak and G. Salanti and P. Cuijpers and E. Schramm",

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Furukawa, TA, Efthimiou, O, Weitz, ES, Cipriani, A, Keller, MB, Kocsis, JH, Klein, DN, Michalak, J, Salanti, G, Cuijpers, P & Schramm, E 2018, 'Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: Personalizing the treatment choice using individual participant data network metaregression', Psychotherapy and Psychosomatics, vol. 87, no. 3, pp. 140-153. https://doi.org/10.1159/000489227

Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: Personalizing the treatment choice using individual participant data network metaregression. / Furukawa, T.A.; Efthimiou, O.; Weitz, E.S. et al.
In: Psychotherapy and Psychosomatics, Vol. 87, No. 3, 06.2018, p. 140-153.

Research output: Contribution to Journal › Article › Academic › peer-review

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AU - Efthimiou, O.

AU - Weitz, E.S.

AU - Cipriani, A.

AU - Keller, M.B.

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N2 - 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

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Furukawa TA, Efthimiou O, Weitz ES, Cipriani A, Keller MB, Kocsis JH et al. Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: Personalizing the treatment choice using individual participant data network metaregression. Psychotherapy and Psychosomatics. 2018 Jun;87(3):140-153. Epub 2018 May 30. doi: 10.1159/000489227

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

Abstract

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Keywords

UN SDGs

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Supplementary Material for: Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression

Supplementary Material for: Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression

Cite this