Finding studies on reboxetine: a tale of hide and seek
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4942 (Published 12 October 2010) Cite this as: BMJ 2010;341:c4942
- Beate Wieseler, deputy head of department of drug assessment,
- Natalie McGauran, researcher,
- Thomas Kaiser, head of department of drug assessment
- 1Institute for Quality and Efficiency in Health Care, Dillenburger Strasse 27, 51105 Cologne, Germany
- Correspondence to: B Wieseler beate.wieseler{at}iqwig.de
- Accepted 16 August 2010
The antidepressant reboxetine, a selective noradrenaline (norepinephrine) reuptake inhibitor, has been approved in several European countries (including the United Kingdom and Germany) since 1997. However, approval was declined in the United States in 2001. The German Institute for Quality and Efficiency in Health Care (IQWiG) report on the benefit and harm of newer antidepressants concluded in 2009 that, overall, reboxetine was both ineffective and potentially harmful.1 2
What is IQWiG?
An independent non-government and non-profit foundation (www.iqwig.de)
Established in 2004 as part of German healthcare reform
Mainly funded by a levy on inpatient and outpatient services
Produces health technology assessments on diagnostic or therapeutic interventions and health economic evaluations for the Federal Joint Committee (G-BA)—the statutory health insurance system’s main decision making body
Publishes evidence based consumer health information (www.informedhealthonline.org)
Appraises clinical practice guidelines
Data from the IQWiG report are published in the accompanying systematic review of reboxetine versus placebo and selective serotonin reuptake inhibitors for acute treatment of major depression, which includes previously unpublished data.3 An additional analysis of published versus both published and unpublished evidence shows that published evidence overestimates the benefit of reboxetine, while underestimating harm. These typical effects of publication bias have been identified (and in part quantified) not only in other research on antidepressants4 5 but in a wide range of treatments.6 7
Biased evidence may form part of a marketing strategy. Analyses of litigation documents, which are available at the Drug Industry Document Archive (http://dida.library.ucsf.edu), have shown how trials and journal publications are used as marketing tools to promote drug use.8 9 A striking example is the promotion of the …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.