Sandeep M Nayak, Bilal A Bari, David B Yaden, Meg J Spriggs, Fernando E Rosas, Joseph M Peill, Bruna Giribaldi, David Erritzoe, David J Nutt, Robin Carhart-Harris
{"title":"裸盖菇素与艾司西酞普兰治疗抑郁症试验的贝叶斯再分析。","authors":"Sandeep M Nayak, Bilal A Bari, David B Yaden, Meg J Spriggs, Fernando E Rosas, Joseph M Peill, Bruna Giribaldi, David Erritzoe, David J Nutt, Robin Carhart-Harris","doi":"10.1089/psymed.2022.0002","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To perform a Bayesian reanalysis of a recent trial of psilocybin (COMP360) versus escitalopram for Major Depressive Disorder (MDD) in order to provide a more informative interpretation of the indeterminate outcome of a previous frequentist analysis.</p><p><strong>Design: </strong>Reanalysis of a two-arm double-blind placebo controlled trial.</p><p><strong>Participants: </strong>Fifty-nine patients with MDD.</p><p><strong>Interventions: </strong>Two doses of psilocybin 25mg and daily oral placebo versus daily escitalopram and 2 doses of psilocybin 1mg, with psychological support for both groups.</p><p><strong>Outcome measures: </strong>Quick Inventory of Depressive Symptomatology-Self-Report (QIDS SR-16), and three other depression scales as secondary outcomes: HAMD-17, MADRS, and BDI-1A.</p><p><strong>Results: </strong>Using Bayes factors and 'skeptical priors' which bias estimates towards zero, for the hypothesis that psilocybin is superior by any margin, we found indeterminate evidence for QIDS SR-16, strong evidence for BDI-1A and MADRS, and extremely strong evidence for HAMD-17. For the stronger hypothesis that psilocybin is superior by a 'clinically meaningful amount' (using literature defined values of the minimally clinically important difference), we found moderate evidence against it for QIDS SR-16, indeterminate evidence for BDI-1A and MADRS, and moderate evidence supporting it for HAMD-17. Furthermore, across the board we found extremely strong evidence for psilocybin's non-inferiority versus escitalopram. These findings were robust to prior sensitivity analysis.</p><p><strong>Conclusions: </strong>This Bayesian reanalysis supports the following inferences: 1) that psilocybin did indeed outperform escitalopram in this trial, but not to an extent that was clinically meaningful--and 2) that psilocybin is almost certainly non-inferior to escitalopram. The present results provide a more precise and nuanced interpretation to previously reported results from this trial, and support the need for further research into the relative efficacy of psilocybin therapy for depression with respect to current leading treatments.</p><p><strong>Trial registration number: </strong>NCT03429075.</p>","PeriodicalId":74590,"journal":{"name":"Psychedelic medicine (New Rochelle, N.Y.)","volume":"1 1","pages":"18-26"},"PeriodicalIF":0.0000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278160/pdf/nihms-1904017.pdf","citationCount":"2","resultStr":"{\"title\":\"A Bayesian Reanalysis of a Trial of Psilocybin versus Escitalopram for Depression.\",\"authors\":\"Sandeep M Nayak, Bilal A Bari, David B Yaden, Meg J Spriggs, Fernando E Rosas, Joseph M Peill, Bruna Giribaldi, David Erritzoe, David J Nutt, Robin Carhart-Harris\",\"doi\":\"10.1089/psymed.2022.0002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To perform a Bayesian reanalysis of a recent trial of psilocybin (COMP360) versus escitalopram for Major Depressive Disorder (MDD) in order to provide a more informative interpretation of the indeterminate outcome of a previous frequentist analysis.</p><p><strong>Design: </strong>Reanalysis of a two-arm double-blind placebo controlled trial.</p><p><strong>Participants: </strong>Fifty-nine patients with MDD.</p><p><strong>Interventions: </strong>Two doses of psilocybin 25mg and daily oral placebo versus daily escitalopram and 2 doses of psilocybin 1mg, with psychological support for both groups.</p><p><strong>Outcome measures: </strong>Quick Inventory of Depressive Symptomatology-Self-Report (QIDS SR-16), and three other depression scales as secondary outcomes: HAMD-17, MADRS, and BDI-1A.</p><p><strong>Results: </strong>Using Bayes factors and 'skeptical priors' which bias estimates towards zero, for the hypothesis that psilocybin is superior by any margin, we found indeterminate evidence for QIDS SR-16, strong evidence for BDI-1A and MADRS, and extremely strong evidence for HAMD-17. For the stronger hypothesis that psilocybin is superior by a 'clinically meaningful amount' (using literature defined values of the minimally clinically important difference), we found moderate evidence against it for QIDS SR-16, indeterminate evidence for BDI-1A and MADRS, and moderate evidence supporting it for HAMD-17. Furthermore, across the board we found extremely strong evidence for psilocybin's non-inferiority versus escitalopram. These findings were robust to prior sensitivity analysis.</p><p><strong>Conclusions: </strong>This Bayesian reanalysis supports the following inferences: 1) that psilocybin did indeed outperform escitalopram in this trial, but not to an extent that was clinically meaningful--and 2) that psilocybin is almost certainly non-inferior to escitalopram. 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A Bayesian Reanalysis of a Trial of Psilocybin versus Escitalopram for Depression.
Objectives: To perform a Bayesian reanalysis of a recent trial of psilocybin (COMP360) versus escitalopram for Major Depressive Disorder (MDD) in order to provide a more informative interpretation of the indeterminate outcome of a previous frequentist analysis.
Design: Reanalysis of a two-arm double-blind placebo controlled trial.
Participants: Fifty-nine patients with MDD.
Interventions: Two doses of psilocybin 25mg and daily oral placebo versus daily escitalopram and 2 doses of psilocybin 1mg, with psychological support for both groups.
Outcome measures: Quick Inventory of Depressive Symptomatology-Self-Report (QIDS SR-16), and three other depression scales as secondary outcomes: HAMD-17, MADRS, and BDI-1A.
Results: Using Bayes factors and 'skeptical priors' which bias estimates towards zero, for the hypothesis that psilocybin is superior by any margin, we found indeterminate evidence for QIDS SR-16, strong evidence for BDI-1A and MADRS, and extremely strong evidence for HAMD-17. For the stronger hypothesis that psilocybin is superior by a 'clinically meaningful amount' (using literature defined values of the minimally clinically important difference), we found moderate evidence against it for QIDS SR-16, indeterminate evidence for BDI-1A and MADRS, and moderate evidence supporting it for HAMD-17. Furthermore, across the board we found extremely strong evidence for psilocybin's non-inferiority versus escitalopram. These findings were robust to prior sensitivity analysis.
Conclusions: This Bayesian reanalysis supports the following inferences: 1) that psilocybin did indeed outperform escitalopram in this trial, but not to an extent that was clinically meaningful--and 2) that psilocybin is almost certainly non-inferior to escitalopram. The present results provide a more precise and nuanced interpretation to previously reported results from this trial, and support the need for further research into the relative efficacy of psilocybin therapy for depression with respect to current leading treatments.
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