Comparing the evidential strength for psychotropic drugs: a Bayesian meta-analysis
Merle-Marie Pittelkow1, Ymkje Anna de Vries2,3, Rei Monden3,4
1Department Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands.
Psychological Medicine
|October 8, 2021
Summary
Psychotropic drug efficacy evidence varied at approval. Attention deficit hyperactivity disorder (ADHD) medications showed the strongest evidence, while antidepressants had weaker support, highlighting the need for clearer statistical communication.
Area of Science:
- Psychiatry and Pharmaceutical Sciences
- Biostatistics and Evidence Synthesis
Background:
- Psychotropic drug prescription relies on evidence of efficacy, necessitating robust evaluation of clinical trial data.
- The strength of evidence supporting psychotropic medications at the time of regulatory approval can vary significantly across different drug classes.
Approach:
- Utilized a Bayesian framework and model-averaged meta-analysis to quantify the evidential strength (BF_BMA) for psychotropic drugs.
- Extracted data from FDA reviews of short-term, placebo-controlled phase II/III clinical trials for antipsychotics, antidepressants (depression and anxiety), and attention deficit hyperactivity disorder (ADHD) medications.
Key Points:
- Attention deficit hyperactivity disorder (ADHD) medications demonstrated the highest median evidential strength (BF_BMA = 1820.4), followed by antipsychotics (BF_BMA = 365.4).
- Antidepressants for depression (BF_BMA = 94.2) and anxiety (BF_BMA = 49.8) exhibited considerably lower and often weak or moderate evidential strength.
- Variations in effect sizes, sample sizes, and the number of trials may explain observed differences in evidential strength across drug groups.
Conclusions:
- While most psychotropic drugs had strong evidence at approval, some lacked substantial support, indicating potential ambiguity.
- Systematic quantification and transparent communication of statistical evidence are crucial for informed clinical decision-making regarding psychotropic medications.
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