Cipriani 2018 Findings — MRCPsych Paper B MCQ

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HardMood DisordersCipriani 2018 FindingsMRCPsych Paper B

In the head-to-head analyses of the 2018 Cipriani network meta-analysis of antidepressants for the acute treatment of adults with major depressive disorder, which group consisted entirely of drugs found to be more effective than other antidepressants?

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Correct answer: E — Amitriptyline, escitalopram, mirtazapine and venlafaxine

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

B is correct. Cipriani and colleagues included 522 randomised trials involving 116,477 adults. In the head-to-head efficacy analyses, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were more effective than other antidepressants; all four drugs in option B belong to this group. Fluoxetine, fluvoxamine, reboxetine and trazodone were among the least efficacious, excluding C. Options A and E mainly resemble groups with favourable acceptability rather than consistently superior efficacy. Option D mixes two relatively efficacious drugs with clomipramine and duloxetine; it also resembles the group associated with higher all-cause discontinuation. The study found that all included antidepressants were more effective than placebo, but relative efficacy and acceptability rankings differed.

Reference: Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018;391:1357–1366. https://pubmed.ncbi.nlm.nih.gov/29477251/