Assessment and management of bipolar disorder: summary of updated NICE guidance

Kendall, Tim; Morriss, Richard; Mayo‐Wilson, Evan; Marcus, Elena

doi:10.1136/bmj.g5673

Cited by 93 publications

(71 citation statements)

References 12 publications

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“…The Endocrine Society commissioned a network meta-analysis to inform recommendations of treatment for its 2012 clinical practice guideline for osteoporosis in men (47, 48). The National Institute for Health and Clinical Excellence in the United Kingdom also used network meta-analysis for developing recommendations for its 2013 neuropathic pain treatment guideline (49) and 2014 bipolar disorder guideline (50). On the basis of these examples and our experience, we provide recommendations for guideline developers who seek to conduct or use a network meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma

Rouse

Cipriani²,

Shi

et al. 2016

Ann Intern Med

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Background Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines. Purpose To compare treatment recommendations for first-line medical therapy for primary open angle-glaucoma (POAG) from major updates of American Academy of Ophthalmology (AAO) guidelines with the evidence available at the time, using network meta-analysis. Data Sources MEDLINE, Embase, and the Cochrane Library were searched on 11 March 2014 for randomized, controlled trials (RCTs) of glaucoma monotherapies compared with placebo, vehicle, or no treatment or other monotherapies. The AAO Web site was searched in August 2014 to identify AAO POAG guidelines. Study Selection Eligible RCTs were selected by 2 independent reviewers, and guidelines were selected by 1 person. Data Extraction One person abstracted recommendations from guidelines and a second person verified. Two people independently abstracted data from included RCTs. Data Synthesis Guidelines were grouped together on the basis of literature search dates, and RCTs that existed at 1991, 1995, 1999, 2004, and 2009 were analyzed. The outcome of interest was intraocular pressure (IOP) at 3 months. Only the latest guideline made a specific recommendation: prostaglandins. Network meta-analyses showed that all treatments were superior to placebo in decreasing IOP at 3 months. The mean reductions (95% credible intervals [CrIs]) for the highest-ranking class compared with placebo were as follows: 1991: β-blockers, 4.01 (CrI, 0.48 to 7.43); 1995: α2-adrenergic agonists, 5.64 (CrI, 1.73 to 9.50); 1999: prostaglandins, 5.43 (CrI, 3.38 to 7.38); 2004: prostaglandins, 4.75 (CrI, 3.11 to 6.44); 2009: prostaglandins, 4.58 (CrI, 2.94 to 6.24). Limitation When comparisons are informed by a small number of studies, the treatment effects and rankings may not be stable. Conclusion For timely recommendations when multiple treatment options are available, guidelines developers should consider network meta-analysis. Primary Funding Source National Eye Institute, National Institutes of Health.

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Section: Discussionmentioning

confidence: 99%

Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma

Rouse

Cipriani²,

Shi

et al. 2016

Ann Intern Med

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“…Age at onset, illness duration, and chronicity of episodes are routinely reported by patients to mental health providers during initial or pre-treatment evaluations. Currently, standard clinical practice guidelines call for a detailed assessment of symptom severity (as evaluated by clinician interview and self-report) to dictate selection of the most appropriate treatment modalities and frequencies (Kendall et al, 2014). Our results suggest that illness history deserves considerable attention in a baseline evaluation as it affects patients’ likely responses to psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: Results from STEP-BD

Deckersbach

Peters

Sylvia

et al. 2016

Journal of Affective Disorders

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Background We sought to address how predictors and moderators of psychotherapy for bipolar depression – identified individually in prior analyses – can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. Methods We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. Results The cluster analysis yielded a two-cluster solution: 1) “less-recurrent/severe” and 2) “chronic/recurrent.” Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p = .040, OR = 4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p = .034, OR = 2.62). Limitations Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. Conclusions A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.

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“…RCTs are considered the gold standard because randomisation is the best method we have to remove selection bias between two groups of patients. However, to randomise participants in a trials, there has to be genuine uncertainty in the clinicians over whether a treatment will be beneficial 4. This is called clinical equipoise, which provides the ethical basis for medical research that involves assigning patients to different treatment arms of a clinical trial 5…”

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confidence: 99%