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In patients undergoing hemodialysis, drug therapy is better than cognitive behavior therapy for depression
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SAN DIEGO — “In patients on dialysis, almost a quarter have depression,” and yet it is often not treated “in part because patients, themselves, are not willing to accept treatment for depression,” according to a researcher here at ASN Kidney Week 2018.
Rajnish Mehrotra, MD, and colleagues conducted a multicenter, randomized controlled trial to look at the use of an engagement interview and its impact on the acceptance of treatment in people undergoing hemodialysis. Researchers also investigated the efficacy of 12-week cognitive behavioral therapy (CBT) vs. sertraline.
“If [it was found that] both the treatments were effective, physicians and patients can choose whichever one is their preference and available to them,” Mehrotra said.
Of the 2,569 patients screened at 41 dialysis centers in three large metro areas, 636 patients had a Beck Depression Inventory score of at least 15 and “were invited to be screened for eligibility (n=310). Of those eligible patients, 184 patients were then randomized to an engagement interview” vs. controls, he said. Patients who had the engagement interview and agreed to treatment were then randomized to receive either CBT (n=60) or sertraline (n=60).
According to Mehrotra, there was no difference in the acceptance of treatment in patients randomized between engagement (66%) vs. control (64%) groups.
“So, it didn’t matter. People were equally likely ... to accept treatment,” he said.
Of those randomized to receive either CBT or sertraline, “there was a decrease in depressive symptoms in people randomized to both CBT and sertraline ... but the decrease was greater in those randomized to sertraline. So, sertraline was more effective in improving depressive symptoms in people on dialysis then CBT,” he said.
The incidence of serious adverse events was similar in each arm of the study. However, non-serious adverse effects were more frequent in patients randomized to sertraline (56 events, 26 patients) vs. CBT (17 events, 12 patients).
“So [sertraline] was more effective, but more adverse events,” Mehrotra said.
Overall, “the treatment effect was modest and most adverse events were mild to moderate.”
This comparative effectiveness RCT could allow for informed decision-making by patients and physicians based on preference, cost and availability, he concluded. – by Joan-Marie Stiglich, ELS
Reference:
Mehrotra R, et al. FR-OR148. Presented at: ASN Kidney Week 2018; Oct. 23-28, 2018; San Diego.
Disclosure: The research was funded by NIDDK and Dialysis Clinic Inc.