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Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis

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Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis. / Lombardo, Giulia; Enache, Daniela; Gianotti, Laura; Schatzberg, Alan F.; Young, Allan; Pariante, Carmine Maria; Mondelli, Valeria.

In: Psychoneuroendocrinology, Vol. 110, 104420, 01.12.2019.

Research output: Contribution to journalArticle

Harvard

Lombardo, G, Enache, D, Gianotti, L, Schatzberg, AF, Young, A, Pariante, CM & Mondelli, V 2019, 'Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis', Psychoneuroendocrinology, vol. 110, 104420. https://doi.org/10.1016/j.psyneuen.2019.104420

APA

Lombardo, G., Enache, D., Gianotti, L., Schatzberg, A. F., Young, A., Pariante, C. M., & Mondelli, V. (2019). Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis. Psychoneuroendocrinology, 110, [104420]. https://doi.org/10.1016/j.psyneuen.2019.104420

Vancouver

Lombardo G, Enache D, Gianotti L, Schatzberg AF, Young A, Pariante CM et al. Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis. Psychoneuroendocrinology. 2019 Dec 1;110. 104420. https://doi.org/10.1016/j.psyneuen.2019.104420

Author

Lombardo, Giulia ; Enache, Daniela ; Gianotti, Laura ; Schatzberg, Alan F. ; Young, Allan ; Pariante, Carmine Maria ; Mondelli, Valeria. / Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis. In: Psychoneuroendocrinology. 2019 ; Vol. 110.

Bibtex Download

@article{7b9ea8caeb554ce4ad531c0e3d2b94a6,
title = "Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis",
abstract = "IntroductionHyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis and high cortisol levels have been widely reported in patients with mood disorders but previous clinical trials investigating the efficacy of antiglucocorticoid treatment in this population have reported inconsistent findings. These inconsistencies among these studies may be because not all patients with mood disorders have increased HPA axis activity and therefore might not benefit from antiglucocorticoid treatment. The aim of this meta-analysis was to investigate whether baseline cortisol levels influence influence the efficacy of antiglucocorticoid drugs in patients with mood disorders.MethodsPubMed and Scopus databases were searched systematically up to October 2018. We included studies using metyrapone, ketoconazole or mifepristone in patients with major depressive disorder, bipolar disorder and major depressive disorder with psychotic symptoms. We tested for a difference in cortisol levels between responders (a reduction equal to or greater than 30{\%} on depression scales following antiglucocorticoid treatment) and non-responders (a reduction of less than 30{\%} on depression scales). We performed a meta-analysis to look specifically at differences in cortisol levels in the sample of patients treated with cortisol synthesis inhibitors (metyrapone and ketoconazole) and in those treated with glucocorticoid receptor (GR) antagonist (mifepristone).ResultsWe were able to retrieve data from 11 of the 16 selected studies and to include 9 studies in the meta-analysis. In the overall sample (N = 846), responders had similar baseline cortisol levels compared with non-responders (standardised mean difference, SMD = -0.03, 95{\%} CI [-0.17, 0.12], p = 0.75). In the group of patients treated with cortisol synthesis inhibitors, responders (N = 109) had significantly higher peripheral baseline cortisol levels compared with non-responders (SMD = 0.42, 95{\%} CI [0.01, 0.83], p = 0.047). In the group of patients treated with a GR antagonist (N = 737), both responders and non-responders had similar baseline cortisol levels (SMD= -0.09, 95{\%} CI [-0.25, 0.07], p = 0.26).ConclusionOur data suggest that only patients with higher cortisol levels at baseline benefit from treatment with cortisol synthesis inhibitors and support a potential role for cortisol as a predictive biomarker for treatment with cortisol synthesis inhibitors in patients with mood disorders.",
keywords = "Antiglucocorticoid, Cortisol, Depression, Metyrapone, Mifepristone, Mood disorders",
author = "Giulia Lombardo and Daniela Enache and Laura Gianotti and Schatzberg, {Alan F.} and Allan Young and Pariante, {Carmine Maria} and Valeria Mondelli",
year = "2019",
month = "12",
day = "1",
doi = "10.1016/j.psyneuen.2019.104420",
language = "English",
volume = "110",
journal = "Psychoneuroendocrinology",
issn = "0306-4530",
publisher = "Elsevier",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Baseline cortisol and the efficacy of antiglucocorticoid treatment in mood disorders: a meta-analysis

AU - Lombardo, Giulia

AU - Enache, Daniela

AU - Gianotti, Laura

AU - Schatzberg, Alan F.

AU - Young, Allan

AU - Pariante, Carmine Maria

AU - Mondelli, Valeria

PY - 2019/12/1

Y1 - 2019/12/1

N2 - IntroductionHyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis and high cortisol levels have been widely reported in patients with mood disorders but previous clinical trials investigating the efficacy of antiglucocorticoid treatment in this population have reported inconsistent findings. These inconsistencies among these studies may be because not all patients with mood disorders have increased HPA axis activity and therefore might not benefit from antiglucocorticoid treatment. The aim of this meta-analysis was to investigate whether baseline cortisol levels influence influence the efficacy of antiglucocorticoid drugs in patients with mood disorders.MethodsPubMed and Scopus databases were searched systematically up to October 2018. We included studies using metyrapone, ketoconazole or mifepristone in patients with major depressive disorder, bipolar disorder and major depressive disorder with psychotic symptoms. We tested for a difference in cortisol levels between responders (a reduction equal to or greater than 30% on depression scales following antiglucocorticoid treatment) and non-responders (a reduction of less than 30% on depression scales). We performed a meta-analysis to look specifically at differences in cortisol levels in the sample of patients treated with cortisol synthesis inhibitors (metyrapone and ketoconazole) and in those treated with glucocorticoid receptor (GR) antagonist (mifepristone).ResultsWe were able to retrieve data from 11 of the 16 selected studies and to include 9 studies in the meta-analysis. In the overall sample (N = 846), responders had similar baseline cortisol levels compared with non-responders (standardised mean difference, SMD = -0.03, 95% CI [-0.17, 0.12], p = 0.75). In the group of patients treated with cortisol synthesis inhibitors, responders (N = 109) had significantly higher peripheral baseline cortisol levels compared with non-responders (SMD = 0.42, 95% CI [0.01, 0.83], p = 0.047). In the group of patients treated with a GR antagonist (N = 737), both responders and non-responders had similar baseline cortisol levels (SMD= -0.09, 95% CI [-0.25, 0.07], p = 0.26).ConclusionOur data suggest that only patients with higher cortisol levels at baseline benefit from treatment with cortisol synthesis inhibitors and support a potential role for cortisol as a predictive biomarker for treatment with cortisol synthesis inhibitors in patients with mood disorders.

AB - IntroductionHyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis and high cortisol levels have been widely reported in patients with mood disorders but previous clinical trials investigating the efficacy of antiglucocorticoid treatment in this population have reported inconsistent findings. These inconsistencies among these studies may be because not all patients with mood disorders have increased HPA axis activity and therefore might not benefit from antiglucocorticoid treatment. The aim of this meta-analysis was to investigate whether baseline cortisol levels influence influence the efficacy of antiglucocorticoid drugs in patients with mood disorders.MethodsPubMed and Scopus databases were searched systematically up to October 2018. We included studies using metyrapone, ketoconazole or mifepristone in patients with major depressive disorder, bipolar disorder and major depressive disorder with psychotic symptoms. We tested for a difference in cortisol levels between responders (a reduction equal to or greater than 30% on depression scales following antiglucocorticoid treatment) and non-responders (a reduction of less than 30% on depression scales). We performed a meta-analysis to look specifically at differences in cortisol levels in the sample of patients treated with cortisol synthesis inhibitors (metyrapone and ketoconazole) and in those treated with glucocorticoid receptor (GR) antagonist (mifepristone).ResultsWe were able to retrieve data from 11 of the 16 selected studies and to include 9 studies in the meta-analysis. In the overall sample (N = 846), responders had similar baseline cortisol levels compared with non-responders (standardised mean difference, SMD = -0.03, 95% CI [-0.17, 0.12], p = 0.75). In the group of patients treated with cortisol synthesis inhibitors, responders (N = 109) had significantly higher peripheral baseline cortisol levels compared with non-responders (SMD = 0.42, 95% CI [0.01, 0.83], p = 0.047). In the group of patients treated with a GR antagonist (N = 737), both responders and non-responders had similar baseline cortisol levels (SMD= -0.09, 95% CI [-0.25, 0.07], p = 0.26).ConclusionOur data suggest that only patients with higher cortisol levels at baseline benefit from treatment with cortisol synthesis inhibitors and support a potential role for cortisol as a predictive biomarker for treatment with cortisol synthesis inhibitors in patients with mood disorders.

KW - Antiglucocorticoid

KW - Cortisol

KW - Depression

KW - Metyrapone

KW - Mifepristone

KW - Mood disorders

UR - http://www.scopus.com/inward/record.url?scp=85071779262&partnerID=8YFLogxK

U2 - 10.1016/j.psyneuen.2019.104420

DO - 10.1016/j.psyneuen.2019.104420

M3 - Article

VL - 110

JO - Psychoneuroendocrinology

JF - Psychoneuroendocrinology

SN - 0306-4530

M1 - 104420

ER -

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