How effective are common medications: a perspective based on meta-analyses of major drugs

BMC Medicine

John M. Davis¹  Gerald Gartlehner²  Bartosz Helfer³  Stefan Leucht³ 

[1] Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA;RTI-International, Research Triangle Park, NC, USA;Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, Munich, 81675, Germany

关键词: Depression;    Schizophrenia;    Standardized mean difference;    Pharmacological interventions;    Percentage response ratio;    Meta-analysis;    Medication efficacy;    Mean difference;    Drug efficacy;    Drug classes;    Common medications;    Absolute risk or response difference;   

Others  :  1228310
DOI  :  10.1186/s12916-015-0494-1

 received in 2015-05-28, accepted in 2015-09-18,  发布年份 2015

【 摘 要 】

The vastness of clinical data and the progressing specialization of medical knowledge may lead to misinterpretation of medication efficacy. To show a realistic perspective on drug efficacy we present meta-analyses on some of the most commonly used pharmacological interventions. For each pharmacological intervention we present statistical indexes (absolute risk or response difference, percentage response ratio, mean difference, standardized mean difference) that are often used to represent efficacy. We found that some of the medications have relatively low effect sizes with only 11 out of 17 of them showing a minimal clinically important difference. Efficacy was often established based on surrogate outcomes and not the more relevant patient-oriented outcomes. As the interpretation of the efficacy of medication is complex, more training for physicians might be needed to get a more realistic view of drug efficacy. That could help prevent harmful overtreatment and reinforce an evidence-based, but personalized medicine.

【 授权许可】

   
2015 Leucht et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010; 7:e1000326.
• [2]Gigerenzer G, Muir Gray J. Better doctors, better patients, better decisions: Envisioning health care 2020. MIT Press, Cambridge, MA; 2011.
• [3]Lenzer J. Unnecessary care: are doctors in denial and is profit driven healthcare to blame? BMJ. 2012; 345:e6230.
• [4]Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012; 200:97-106.
• [5]Aitken M, Kleinrock M, Lyle J, Caskey L. Medicine use and shifting costs of healthcare. A review of the use of medicines in the United States in 2013. IMS Institute for Healthcare Informatics, Danbury, CT; 2014.
• [6]Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ; 1988.
• [7]Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J et al.. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009; 62:1013-1020.
• [8]Khan M, Santana J, Donnellan C, Preston C, Moayyedi P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev. 2007; 2:CD003244.
• [9]Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011; 9:CD008659.
• [10]Law M, Morris JK, Jordan R, Wald N. Headaches and the treatment of blood pressure: results from a meta-analysis of 94 randomized placebo-controlled trials with 24,000 participants. Circulation. 2005; 112:2301-2306.
• [11]Antithrombotic Trialists C, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J et al.. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009; 373:1849-1860.
• [12]Undurraga J, Baldessarini RJ. Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology. 2012; 37:851-864.
• [13]Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003; 41:582-592.
• [14]Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003; 326:1423.
• [15]Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C et al.. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366:1267-1278.
• [16]Turnbull F. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet. 2003; 362:1527-1535.
• [17]Saenz A, Fernandez-Esteban I, Mataix A, Ausejo M, Roque M, Moher D. Metformin monotherapy for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005; 3:CD002966.
• [18]Boussageon R, Supper I, Bejan-Angoulvant T, Kellou N, Cucherat M, Boissel JP et al.. Reappraisal of metformin efficacy in the treatment of type 2 diabetes: a meta-analysis of randomised controlled trials. PLoS Med. 2012; 9:e1001204.
• [19]Covey J. A meta-analysis of the effects of presenting treatment benefits in different formats. Med Decis Making. 2007; 27:638-654.
• [20]Glue P, Donovan MR, Kolluri S, Emir B. Meta-analysis of relapse prevention antidepressant trials in depressive disorders. Aust N Z J Psychiatry. 2010; 44:697-705.
• [21]van Deemter K. Not exactly: In praise of vagueness. Oxford University Press, Oxford; 2010.
• [22]Kahneman D. Thinking fast and slow. Farrar, Straus and Giroux, New York, NY; 2011.
• [23]Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006; 1:CD005593.
• [24]Faraone SV, Buitelaar J. Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry. 2010; 19:353-364.
• [25]Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000; 162:225-233.
• [26]Leucht S, Arbter D, Engel RR, Kissling W, Davis JM. How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Mol Psychiatry. 2009; 14:429-447.
• [27]MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M et al.. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008; 148:197-213.
• [28]Nabi G, Cody JD, Ellis G, Herbison P, Hay-Smith J. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006; 4:CD003781.
• [29]Sin DD, Man J, Sharpe H, Gan WQ, Man SF. Pharmacological management to reduce exacerbations in adults with asthma: a systematic review and meta-analysis. JAMA. 2004; 292:367-376.
• [30]Barr RG, Bourbeau J, Camargo CA, Ram FS. Tiotropium for stable chronic obstructive pulmonary disease: A meta-analysis. Thorax. 2006; 61:854-862.
• [31]Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev. 2012; 2:CD008615.
• [32]Fahn S, Oakes D, Shoulson I, Kieburtz K, Rudolph A, Lang A et al.. Levodopa and the progression of Parkinson’s disease. N Engl J Med. 2004; 351:2498-2508.