TY - JOUR
T1 - Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression
T2 - A meta-analysis of randomized controlled trials
AU - Nunez, Nicolas A.
AU - Singh, Balwinder
AU - Romo-Nava, Francisco
AU - Joseph, Boney
AU - Veldic, Marin
AU - Cuellar-Barboza, Alfredo
AU - Cabello Arreola, Alejandra
AU - Vande Voort, Jennifer L.
AU - Croarkin, Paul
AU - Moore, Katherine M.
AU - Biernacka, Joanna
AU - McElroy, Susan L.
AU - Frye, Mark A.
N1 - Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Objective: The aim of this study was to evaluate the efficacy and safety of the dopaminergic-enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. Methods: A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP-I) or bipolar II (BP-II) depression. Data for response/remission and all-cause discontinuation were analyzed. Effect size was summarized by relative risk (RR) using a random effect model. Results: Of 58 studies, five RCTs (N = 795 drug, N = 792 placebo) met inclusion criteria. Four armodafinil studies included only BP-I patients and one modafinil study included both bipolar subtypes with limited heterogeneity (I2 = 34%, P =.19; I2 = 18%, P =.30). Compared to placebo, augmentation with MoArm was associated with significantly greater rates of treatment response (RR, 1.18; 95% CI, 1.01-1.37; P =.03) and remission (RR, 1.38; 95% CI, 1.10-1.73; P =.005). All-cause discontinuation was not different than placebo (RR, 1.08; 95% CI, 0.89-1.30; P =.45) with no evidence of increased risk of mood switch or suicide attempts with MoArm (RR, 0.99; 95% CI, 0.39-2.5; P =.98; RR, 1.02; 95% CI, 0.37-2.85; P =.97). Conclusion: This narrower scope meta-analysis of one drug for one disease suggests that adjunctive MoArm may represent a novel therapeutic intervention. Further studies delineating the subtypes of bipolar depression responsive to these novel dopaminergic-enhancing agents are encouraged.
AB - Objective: The aim of this study was to evaluate the efficacy and safety of the dopaminergic-enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. Methods: A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP-I) or bipolar II (BP-II) depression. Data for response/remission and all-cause discontinuation were analyzed. Effect size was summarized by relative risk (RR) using a random effect model. Results: Of 58 studies, five RCTs (N = 795 drug, N = 792 placebo) met inclusion criteria. Four armodafinil studies included only BP-I patients and one modafinil study included both bipolar subtypes with limited heterogeneity (I2 = 34%, P =.19; I2 = 18%, P =.30). Compared to placebo, augmentation with MoArm was associated with significantly greater rates of treatment response (RR, 1.18; 95% CI, 1.01-1.37; P =.03) and remission (RR, 1.38; 95% CI, 1.10-1.73; P =.005). All-cause discontinuation was not different than placebo (RR, 1.08; 95% CI, 0.89-1.30; P =.45) with no evidence of increased risk of mood switch or suicide attempts with MoArm (RR, 0.99; 95% CI, 0.39-2.5; P =.98; RR, 1.02; 95% CI, 0.37-2.85; P =.97). Conclusion: This narrower scope meta-analysis of one drug for one disease suggests that adjunctive MoArm may represent a novel therapeutic intervention. Further studies delineating the subtypes of bipolar depression responsive to these novel dopaminergic-enhancing agents are encouraged.
KW - armodafinil
KW - augmentation strategy
KW - bipolar depression
KW - meta-analysis
KW - modafinil
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U2 - 10.1111/bdi.12859
DO - 10.1111/bdi.12859
M3 - Review article
C2 - 31643130
AN - SCOPUS:85077885090
SN - 1398-5647
VL - 22
SP - 109
EP - 120
JO - Bipolar disorders
JF - Bipolar disorders
IS - 2
ER -