Electroconvulsive therapy effectiveness was comparable between research and real-world cohorts after adjusting for patient selection criteria (response OR 1.20, 95% CI 0.86-1.69).
Cohort (n=1,892)
Yes
Does the effectiveness of electroconvulsive therapy differ between research and real-world cohorts in patients with major depressive disorder?
Electroconvulsive therapy demonstrates comparable effectiveness across research and real-world settings once patient selection criteria are accounted for.
Effect estimate: OR 1.46 (95% CI 1.09-1.95)
Absolute Event Rate: 66.8% vs 58.9%
Background Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder, yet real-world outcomes may differ from research studies. We compared ECT effectiveness in research versus real-world cohorts and examined whether in- and exclusion criteria and treatment characteristics explain potential differences. Method 1892 patients with MDD from the Dutch ECT Consortium (12 research, 10 real-world cohorts) were included. Outcomes were response (≥50% HDRS reduction), remission (HDRS <8), and change in depression severity (Δ-HDRS). Cohorts were compared on effectiveness and demographic, clinical and treatment characteristics. Logistic and linear regression estimated associations between cohort type and outcomes, unadjusted and adjusted for in- and exclusion criteria and additional clinical confounders. Results Research cohorts demonstrated higher response rates (66.8% vs. 58.9%, OR 1.46, 95% CI 1.09–1.95) and greater symptom reduction (B 2.88, 95% CI 1.86–3.90), while remission rates did not differ significantly. Cohorts differed on several clinical and treatment characteristics, partly reflecting in- and exclusion criteria used in research cohorts. After adjusting for these selection criteria, differences in response and Δ-HDRS were no longer significant (OR 1.20, 95% CI 0.86–1.69; B 0.61, 95% CI −0.29–1.51). Adjustment for additional confounders marginally changed these estimates. In sensitivity analyses restricted to mixed-sites, differences were not significant in unadjusted and adjusted models. Conclusion In the Dutch ECT consortium, ECT demonstrates comparable effectiveness across research and real-world settings once patient selection is accounted for. These findings underscore the importance of considering cohort composition when interpreting treatment outcomes.
Cobben et al. (Fri,) conducted a cohort in Major depressive disorder (MDD) (n=1,892). Electroconvulsive therapy (ECT) in research cohorts vs. Electroconvulsive therapy (ECT) in real-world cohorts was evaluated on Response (≥50% HDRS reduction) (OR 1.46, 95% CI 1.09-1.95). Electroconvulsive therapy effectiveness was comparable between research and real-world cohorts after adjusting for patient selection criteria (response OR 1.20, 95% CI 0.86-1.69).