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Randomized Controlled Trial
. 2015 Nov;23(11):1127-33.
doi: 10.1016/j.jagp.2015.05.006. Epub 2015 May 19.

Time to Response to Citalopram Treatment for Agitation in Alzheimer Disease

Daniel Weintraub  1 , Lea T Drye  2 , Anton P Porsteinsson  3 , Paul B Rosenberg  4 , Bruce G Pollock  5 , Devangere P Devanand  6 , Constantine Frangakis  2 , Zahinoor Ismail  7 , Christopher Marano  4 , Curtis L Meinert  2 , Jacobo E Mintzer  8 , Cynthia A Munro  4 , Gregory Pelton  6 , Peter V Rabins  4 , Lon S Schneider  9 , David M Shade  2 , Jerome Yesavage  10 , Constantine G Lyketsos  4 ; CitAD Research Group
Affiliations
Randomized Controlled Trial

Time to Response to Citalopram Treatment for Agitation in Alzheimer Disease

Daniel Weintraub et al. Am J Geriatr Psychiatry. 2015 Nov.

Abstract

Objective: Agitation is a common and significant problem in Alzheimer disease (AD). In the recent Citalopram for Agitation in Alzheimer's Disease (CitAD) study, citalopram was efficacious for the treatment of AD agitation. Here we examined the time course and predictors of response to treatment.

Methods: Response in CitAD was defined as a modified Alzheimer Disease Cooperative Study Clinical Global Impression of Change (CGIC) score of 1 or 2 or a Neurobehavioral Rating Scale agitation subscale (NBRS-A) score reduction ≥ 50% from baseline. "Stable early response" was defined as meeting the aforementioned criteria at both weeks 3 and 9, "late response" was response at week 9 but not at week 3, and "unstable response" was response at week 3 but not at week 9.

Results: In the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. Little between-group differences were found in response rates in the first 3 weeks of the study (21% versus 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% versus 8% on CGIC, Fisher's exact p = 0.09; 31% versus 15% on NBRS-A, Fisher's exact p = 0.02). Approximately half of citalopram responders (45%-56%) at end of study achieved response later in the study compared with 30%-44% of placebo responders.

Conclusion: Treatment with citalopram for agitation in AD needs to be at least 9 weeks in duration to allow sufficient time for full response. Study duration is an important factor to consider in the design of clinical trials for agitation in AD.

Keywords: Agitation; Alzheimer disease; citalopram.

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Figures

Figure 1
Figure 1. Time course for response on CGIC and NBRS-A by treatment assignmenta
aProportion responding with exact (Clopper Pearson) confidence intervals.
See this image and copyright information in PMC

References

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    1. Porsteinsson A, Drye LT, Pollock BG, Devanand DP, Frangakis C, Ismail Z, et al. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014;311(7):682–691. - PMC - PubMed
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