Gerald Gartlehner, MD, MPH; Bradley N. Gaynes, MD, MPH; Richard A. Hansen, PhD, RPh; Patricia Thieda, MA; Angela DeVeaugh-Geiss, MS; Erin E. Krebs, MD, MPH; Charity G. Moore, PhD, MSPH; Laura Morgan, MA; Kathleen N. Lohr, PhD
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
Acknowledgment: The authors thank Timothy S. Carey, MD, MPH, and Stacey Williams, MA, from the University of North Carolina at Chapel Hill, and also Linda Lux, MPA, and Loraine Monroe of RTI International.
Grant Support: By a contract from the Agency for Healthcare Research and Quality to the RTI International–University of North Carolina Evidence-based Practice Center (contract no. 290-02-0016).
Potential Financial Conflicts of Interest:Employment: A. DeVeaugh-Geiss (GlaxoSmithKline). Consultancies: B.N. Gaynes (Pfizer, Wyeth-Ayerst, Shire Pharmaceutical). Honoraria: B.N. Gaynes (GlaxoSmithKline). Stock ownership or options (other than mutual funds): A. DeVeaugh-Geiss (GlaxoSmithKline). Expert testimony: B.N. Gaynes (Phillips Lytle). Grants received: B.N. Gaynes (Agency for Healthcare Research and Quality, National Institute of Mental Health, Bristol-Myers Squibb, Novartis, Pfizer, Robert Wood Johnson Foundation, M-3 Corporation), R.A. Hansen (GlaxoSmithKline). Grants pending: B.N. Gaynes (National Institute of Mental Health, Agency for Healthcare Research and Quality).
Requests for Single Reprints: Gerald Gartlehner, MD, MPH, Danube University, Karl Dorrek-Straße, 3500 Krems, Austria; e-mail, email@example.com.
Current Author Addresses: Dr. Gartlehner: Danube University, Karl Dorrek-Straße, 3500 Krems, Austria.
Dr. Gaynes: Department of Psychiatry, Campus Box 7160, University of North Carolina, Chapel Hill, NC 27599.
Dr. Hansen: University of North Carolina, School of Pharmacy, Campus Box 7360, Chapel Hill, NC 27599.
Ms. Thieda and Ms. Morgan: University of North Carolina, Sheps Center for Health Services Research, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
Ms. DeVeaugh-Geiss: University of North Carolina, Department of Epidemiology, Campus Box 7435, Chapel Hill, NC 27599.
Dr. Krebs: Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202.
Dr. Moore: Center for Research on Health Care Data, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213.
Dr. Lohr: RTI International, PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194.
Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, et al. Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians. Ann Intern Med. 2008;149:734-750. doi: 10.7326/0003-4819-149-10-200811180-00008
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Published: Ann Intern Med. 2008;149(10):734-750.
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Thomas E. Finucane
Johns Hopkins School of Medicine
December 5, 2008
Comparative Benefits and Harms of Second-Generation Antidepressants
Dr. Gartlehner and colleague's Background Paper on the comparative benefits and harms of second-generation antidepressants (SGAs) finds "no substantial differences in efficacy among these drugs," but notes that "other differences" may be relevant in choosing a drug (1). They also note that 69% of the studies were supported by the pharmaceutical industry, and for 21% of the studies, source of funding could not be determined. Drug company funding has a strong impact on the published literature. Companies naturally tend to seek publication of results favorable to their products (2).
Seven fair quality studies are cited, all showing that mirtazapine leads to higher weight gain than other SGAs; not shown is that all seven studies are sponsored by mirtazapine's vendor, Organon, and that three of the seven have at least one author who is a drug company employee. Without any good evidence, a market niche for mirtazapine has been created: depressed patients who are losing weight.
Writers of systematic reviews must decide how to weigh vendor-sponsored evidence, especially when most or all of the available evidence is vendor-sponsored. Here is a modest suggestion. In bibliographies, why not make the first initial of the first author scarlet if the paper is sponsored by the vendor? This would make it easy to see where the influence of industry might be suspected.
1. Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, Moore CG, et al. Comparative benefits and harms of second-generation antidepressants: Background paper for the American College of Physicians. Ann Intern Med. 2008; 149: 734-750.
2. Rising K, Bacchetti P, Bero L. Reporting bias in drug trials submitted to the Food and Drug Administration: A review of publication and presentation. PLoS Med 2008; 5(11): e217: 0001-10.
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