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April 17, 2002

Is One Selective Serotonin Reuptake Inhibitor Better Than Another?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor


Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

JAMA. 2002;287(15):1935-1938. doi:10.1001/jama.287.15.1935

In Reply: Most of the specific concerns expressed in these letters can be addressed by emphasizing several fundamental principles. First, we compared 3 drugs on many outcomes at 4 follow-up time points. The problem of multiple hypothesis testing is exacerbated if one does pairwise comparisons of drugs as suggested because, for each outcome, there are 3 potential pairwise comparisons: paroxetine vs fluoxetine, paroxetine vs sertraline, and fluoxetine vs sertraline. Focusing on the 25 outcomes in Tables 2 and 3 would result in 300 pairwise comparisons (25 outcomes × 3 pairwise comparisons × 4 follow-up time points). Including other outcomes reported in Tables 4 and 5 and the text could result in more than 450 pairwise comparisons. Contrast this with a standard clinical trial that examines 1 primary outcome at 1 end point, such as depression severity at 12 weeks in a comparative study of 2 antidepressants.

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