Multi-state outcome analysis of treatments (MOAT): application of a new approach to evaluate outcomes in longitudinal studies of bipolar disorder

Molecular Psychiatry
Charles L BowdenMauricio Tohen

Abstract

Survival analyzes are usually based on a single point in time predefined event. Dissatisfied with this approach to evaluating maintenance treatment outcomes, we developed the Multi-state Outcome Analysis of Treatments (MOAT) methodology using a combined database from two FDA registration studies of lamotrigine, lithium and placebo. MOAT partitions total survival time into clinically distinct periods operationally defined by cutpoints on rating scales. For bipolar disorder (BD), the clinical states are remission, subsyndromal and syndromal mania, mixed states or depression. MOAT results can be crossed with information about tolerability and functioning to yield an outcome system integrating efficacy and tolerability. As found in the original analysis, both drugs were associated with longer time in study compared with the placebo. MOAT supplements this by finding that both drugs increased the time remitted compared with placebo. However, a substantial amount of time in all three treatments was spent in subsyndromal depression. Time with manic symptoms was reduced with lithium, but not lamotrigine. Patients on placebo neither benefitted nor had adverse effects from the assignment but experienced more syndromal levels of symptoms a...Continue Reading

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Citations

Oct 20, 2015·Expert Opinion on Pharmacotherapy·Charles L Bowden, Vivek Singh
Jul 28, 2016·Twin Research and Human Genetics : the Official Journal of the International Society for Twin Studies·Dever M CarneyJohn M Hettema
Oct 7, 2016·Science·Teruhiro OkuyamaSusumu Tonegawa
Oct 16, 2016·Development and Psychopathology·Ian R Gizer
Jan 27, 2016·Epidemiology and Psychiatric Sciences·R C KesslerA M Zaslavsky
Mar 23, 2018·Expert Opinion on Pharmacotherapy·Charles Bowden, Melissa Martinez
Jun 10, 2017·Development and Psychopathology·Charlotte A M CecilEdward D Barker
Oct 6, 2017·Schizophrenia Bulletin·Nickole Kanyuch, Stewart Anderson
Jun 22, 2020·Bipolar Disorders·Jan ScottFrank Bellivier
Sep 21, 2017·The International Journal of Neuropsychopharmacology·Mauricio Tohen
Apr 3, 2021·Therapeutic Advances in Psychopharmacology·Mutahira M Qureshi, Allan H Young

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Software Mentioned

SAS
MOAT
SAS GENMOD
SAS LCA

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