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Infliximab for Treatment-Resistant Depression

Article: A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers. JAMA Psychiatry. 2013;70(1):31-41

Summary

Study examines the role of inflammatory biomarkers and response of patients with treatment resistant depression.

Abstract

Context Increased concentrations of inflammatory biomarkers predict antidepressant nonresponse, and inflammatory cytokines can sabotage and circumvent the mechanisms of action of conventional antidepressants.

Objectives To determine whether inhibition of the inflammatory cytokine tumor necrosis factor (TNF) reduces depressive symptoms in patients with treatment‑resistant depression and whether an increase in baseline plasma inflammatory biomarkers, including high‑sensitivity C‑reactive protein (hs‑CRP), TNF, and its soluble receptors, predicts treatment response.

Design Double‑blind, placebo‑controlled, randomized clinical trial.

Setting Outpatient infusion center at Emory University in Atlanta, Georgia.

Participants A total of 60 medically stable outpatients with major depression who were either on a consistent antidepressant regimen (n = 37) or medication‑free (n = 23) for 4 weeks or more and who were moderately resistant to treatment as determined by the Massachusetts General Hospital Staging method.

Interventions Three infusions of the TNF antagonist infliximab (5 mg/kg) (n = 30) or placebo (n = 30) at baseline and weeks 2 and 6 of a 12‑week trial.

Main Outcome Measures The 17‑item Hamilton Scale for Depression (HAM‑D) scores.

Results No overall difference in change of HAM‑D scores between treatment groups across time was found. However, there was a significant interaction between treatment, time, and log baseline hs‑CRP concentration (P = .01), with change in HAM‑D scores (baseline to week 12) favoring infliximab‑treated patients at a baseline hs‑CRP concentration greater than 5 mg/L and favoring placebo‑treated patients at a baseline hs‑CRP concentration of 5 mg/L or less. Exploratory analyses focusing on patients with a baseline hs‑CRP concentration greater than 5 mg/L revealed a treatment response (≥50% reduction in HAM‑D score at any point during treatment) of 62% (8 of 13 patients) in infliximab‑treated patients vs 33% (3 of 9 patients) in placebo‑treated patients (P = .19). Baseline concentrations of TNF and its soluble receptors were significantly higher in infliximab‑treated responders vs nonresponders (P < .05), and infliximab‑treated responders exhibited significantly greater decreases in hs‑CRP from baseline to week 12 compared with placebo‑treated responders (P < .01). Dropouts and adverse events were limited and did not differ between groups.

Conclusions This proof‑of‑concept study suggests that TNF antagonism does not have generalized efficacy in treatment‑resistant depression but may improve depressive symptoms in patients with high baseline inflammatory biomarkers.

Interview with Andrew H. Miller, MD, author of A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers

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Infliximab contra la depresión resistente al tratamiento

Artículo: Ensayo controlado aleatorizado del antagonista del factor de necrosis tumoral infliximab para la depresión resistente al tratamiento. JAMA Psychiatry. 2013;70(1):31-41

Summary

En un estudio se examina la función de los biomarcadores inflamatorios y la respuesta de los pacientes a la depresión resistente al tratamiento.

Entrevista con Andrew H. Miller, MD, autor de Ensayo controlado aleatorizado del antagonista del factor de necrosis tumoral infliximab para la depresión resistente al tratamiento

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Utilisation de l'infliximab dans le cadre d'un trouble dépressif résistant au traitement

Article: Essai contrôlé randomise sur un antagoniste du facteur de nécrose tumorale, l'infliximab, utilisé dans le cadre d'un trouble dépressif résistant au traitement. JAMA Psychiatry. 2013;70(1):31-41.

Summary

Une étude examine le rôle de biomarqueurs inflammatoires et la réponse de patients présentant un trouble dépressif résistant au traitement.

Entretien avec Andrew H. Miller, MD, auteur de Corrélation entre la coqueluche chez l'enfant et la primovaccination en fonction du temps écoulé depuis l'injection finale

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Infliximab per la depressione resistente al trattamento

Articolo: Studio controllato randomizzato sull'Infliximab, antagonista del fattore di necrosi tumorale, per la depressione resistente al trattamento. JAMA Psychiatry. 2013;70(1):31-41.

Summary

Lo studio analizza il ruolo dei biomarcatori infiammatori e la risposta dei pazienti con depressione resistente al trattamento.

Intervista a Andrew H. Miller, MD, autore di Studio controllato randomizzato sull'Infliximab, antagonista del fattore di necrosi tumorale, per la depressione resistente al trattamento. /p>

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英夫利昔单抗治疗难治性抑郁症

文章: 肿瘤坏死因子拮抗剂英夫利昔单抗治疗难治性抑郁症的随机对照试验。 JAMA Psychiatry. 2013;70(1):31-41.

Summary

研究探讨炎症标志物在难治性抑郁症患者治疗中的作用和疗效

专访 Andrew H. Miller, MD, 作者 肿瘤坏死因子拮抗剂英夫利昔单抗治疗难治性抑郁症的随机对照试验。

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Infliximab for Treatment-Resistant Depression

статья: A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers. JAMA Psychiatry. 2013;70(1):31-41.

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Интервью с Andrew H. Miller, MD, автор A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers.

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Infliximab for Treatment-Resistant Depression

Artigo: A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers. JAMA Psychiatry. 2013;70(1):31-41.

Summary

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Entrevista com o Andrew H. Miller, MD, autor de A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment Resistant Depression: The Role of Baseline Inflammatory Biomarkers.

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Infliximab zur Behandlung von therapieresistenter Depression

Artikel: Eine randomisierte, kontrollierte Studie des Tumornekrosefaktor-Antagonisten Infliximab bei therapieresistenter Depression. JAMA Psychiatry. 2013;70(1):31-41.

Summary

In einer Studie werden die Rolle von Biomarkern für Entzündungen und das Ansprechen von Patienten mit therapieresistenter Depression untersucht

Interview mit Andrew H. Miller, MD, autor Eine randomisierte, kontrollierte Studie des Tumornekrosefaktor-Antagonisten Infliximab bei therapieresistenter Depression.

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