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Controlling for Drug Dose in Systematic Review and Meta-Analysis: A Case Study of the Effect of Antidepressant Dose

Author

Listed:
  • Richard A. Hansen

    (University of North Carolina-School of Pharmacy, Chapel Hill, rahansen@unc.edu)

  • Charity G. Moore

    (University of Pittsburgh-School of Medicine)

  • Stacie B. Dusetzina

    (University of North Carolina-School of Pharmacy, Chapel Hill)

  • Brian I. Leinwand

    (University of North Carolina-School of Pharmacy, Chapel Hill)

  • Gerald Gartlehner

    (Department for Clinical Epidemiology and Evidence-based Medicine, Danube University, Krems, Austria)

  • Bradley N. Gaynes

    (University of North Carolina-School of Medicine, Chapel Hill)

Abstract

Purpose . To describe a method for quantitatively dealing with drug dose in comparative effectiveness reviews. Second-generation antidepressants are used as an example to illustrate this method and to determine whether dose influences conclusions on comparative effectiveness. Methods . Studies previously identified in a systematic review of second-generation antidepressants were included if data on drug dose were available. The usual dosing range for each drug was defined and then used to create 2- and 3-level dose categories. Placebo-controlled data were used to calculate overall effect sizes for the drug class and effect sizes stratified by drug dose. Meta-regression tested the impact of dose on effect size. Weighted mean differences and risk ratios were calculated for comparative studies, stratifying by whether compared doses were equivalent. Results . The dose classification method was able to identify dose-response trends in the context of meta-analysis. Compared to low-dose studies, medium- and high-dose studies had a 1- to 2-point greater differential in mean Hamilton Depression Rating Scale (HAM-D) change ( P

Suggested Citation

  • Richard A. Hansen & Charity G. Moore & Stacie B. Dusetzina & Brian I. Leinwand & Gerald Gartlehner & Bradley N. Gaynes, 2009. "Controlling for Drug Dose in Systematic Review and Meta-Analysis: A Case Study of the Effect of Antidepressant Dose," Medical Decision Making, , vol. 29(1), pages 91-103, January.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:1:p:91-103
    DOI: 10.1177/0272989X08323298
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