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Titolo:
Clomipramine concentration as a predictor of delayed response: a naturalistic study
Autore:
Gex-Fabry, M; Balant-Gorgia, AE; Balant, LP;
Indirizzi:
Dept Psychiat, Clin Res Unit, CH-1225 Chene Bourg, Switzerland Dept Psychiat Chene Bourg Switzerland CH-1225 5 Chene Bourg, Switzerland Univitzerlandeva, Dept Psychiat, Therapeut Drug Monitoring Unit, Geneva, Sw Univ Hosp Geneva Geneva Switzerland ut Drug Monitoring Unit, Geneva, Sw
Titolo Testata:
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
fascicolo: 12, volume: 54, anno: 1999,
pagine: 895 - 902
SICI:
0031-6970(199902)54:12<895:CCAAPO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRUE DRUG RESPONSE; ANTIDEPRESSANT TREATMENT; CLINICAL-RESPONSE; PLACEBO-RESPONSE; PATTERN-ANALYSIS; ONSET; TRIALS; PLASMA; PHARMACOKINETICS; DEPRESSION;
Keywords:
concentration-effect relationship; clomipramine; naturalistic study;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Gex-Fabry, M DeptSwitzerlandClin Res Unit, 2 Chemin Petit Bel Air, CH-1225Chene Bourg, Dept Psychiat 2 Chemin Petit Bel Air Chene Bourg SwitzerlandCH-1225
Citazione:
M. Gex-Fabry et al., "Clomipramine concentration as a predictor of delayed response: a naturalistic study", EUR J CL PH, 54(12), 1999, pp. 895-902

Abstract

Objectives: The aim of the present study was to characterise onset of response to clomipramine treatment in a naturalistic setting and to investigatethe relationship between concentration and delayed response, postulated toreflect drug-specific response to antidepressant therapy. Methods: Ninety-eight depressed patients were prescribed clomipramine in an open flexible manner and followed for depressive symptoms (Montgomery-Asberg depression scale) over a maximum 12 weeks follow-up period. All patients had at least one concentration measurement for therapeutic drug monitoring purpose. Results: Firstly, survival analysis revealed a probability of 15.4% for patients not to show 50% improvement over baseline by week 12, and thus to beconsidered as non-responders. Median time to onset of response was 31 daysfor responders, indicating a relatively high probability of delayed response under routine treatment. Secondly, pattern analysis indicated a significant association between early and abrupt response on the one hand and delayed and gradual response on the other. A tendency towards an association between delayed and persistent response was also observed. Finally, receiver operating characteristics analysis allowed identification of a highly significant lower threshold of 230 ng.ml(-1) for the sum of clomipramine and desmethyl-clomipramine, as measured at week 3, with respect to response from week 3 onward. Predictive values were 68.8% and 81.0% for concentrations above and below this threshold to predict delayed response and non-response, respectively. Thresholds were 55 ng.ml(-1) for parent compound and 180 ng.ml(-1) for metabolite. Conclusion: This approach supports the hypothesis that delayed response may be concentration dependent and thus may reflect true drug effect. As a consequence, monitoring clomipramine concentration about 3 weeks after initiation of therapy may valuably contribute to help clinicians decide about theadequacy of ongoing therapy.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/08/20 alle ore 17:04:53