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Title: Durability of symptomatic responses obtained with adjunctive vagus nerve stimulation in treatment-resistant depression
Authors: Kumar, A.
Bunker, M.T.
Aaronson, S.T.
Conway, C.R.
Rothschild, A.J.
Mordenti, G.
Rush, A.J. 
Keywords: Depressive disorder
Durability of response
Longitudinal study
Treatment-resistant depression
Vagus nerve stimulation
Issue Date: 2019
Publisher: Dove Medical Press Ltd.
Citation: Kumar, A., Bunker, M.T., Aaronson, S.T., Conway, C.R., Rothschild, A.J., Mordenti, G., Rush, A.J. (2019). Durability of symptomatic responses obtained with adjunctive vagus nerve stimulation in treatment-resistant depression. Neuropsychiatric Disease and Treatment 15 : 457-468. ScholarBank@NUS Repository.
Rights: Attribution-NonCommercial 4.0 International
Abstract: Objective: To compare the durations of response achieved with adjunctive vagus nerve stimulation (VNS + TAU) vs treatment as usual (TAU) alone in treatment-resistant depression (TRD) over a 5-year period in the TRD registry. Materials and methods: Data from 271 participants on TAU and 328 participants on VNS + TAU were analyzed. Response was defined as ?50% decrease in baseline Montgomery–Åsberg Depression Rating Scale (MADRS) score at postbaseline visit and was considered retained until the decrease was <40%. MADRS was obtained quarterly in year 1 and biannually thereafter. Time-to-events were estimated using Kaplan–Meier method and compared using log-rank test. HR was estimated using Cox proportion hazard model. Results: In the VNS + TAU arm, 62.5% (205/328) of participants had a first response over 5 years compared with 39.9% (108/271) in TAU. The time to first response was significantly shorter for VNS + TAU than for TAU (P<0.01). For responders in the first year, median time to relapse from first response was 10.1 months (Q1=4.2, Q3=31.5) for VNS + TAU vs 7.3 months (Q1=3.1, Q3=17.6) for TAU (P<0.01). HR=0.6 (95% CI: 0.4, 0.9) revealed a significantly lower chance for relapse in VNS + TAU. Probability of retaining first response for a year was 0.39 (0.27, 0.51) for TAU and 0.47 (0.38, 0.56) for VNS + TAU. Timing of the onset of the response did not impact the durability of the response. Conclusion: VNS therapy added to TAU in severe TRD leads to rapid onset and higher likelihood of response, and a greater durability of the response as compared to TAU alone. © 2019 Kumar et al.
Source Title: Neuropsychiatric Disease and Treatment
ISSN: 11766328
DOI: 10.2147/NDT.S196665
Rights: Attribution-NonCommercial 4.0 International
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