Objective.
Escitalopram is the most selective of the
serotonin reuptake inhibitors. Methods. We review all the clinical trials (three pivotal placebo-controlled trials with
citalopram as an active reference, one long-term non-inferiority study and one head-to-head superiority study) that include
citalopram as an active reference in
major depressive disorder (MDD), and studies that evaluate the cost-effectiveness of the two drugs. Results. In two of the pivotal studies and in the long-term study,
escitalopram was numerically better than
citalopram in reducing Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline, with comparative tolerability. Meta-analyses of these studies showed statistically significant differences in favour of
escitalopram in terms of reducing MADRS and increasing response. This effect was particularly apparent in patients with higher baseline MADRS scores. These trends were confirmed in a head-to-head study, which clearly demonstrated the superiority of
escitalopram compared with
citalopram on primary and secondary endpoints. The difference between treatments was clinically relevant. Cost-effectiveness analyses demonstrated that although
escitalopram has a slightly higher unit cost than generic
citalopram, expected direct medical and productivity- related costs were lower with
escitalopram than
citalopram. Conclusion. On the basis of these results,
escitalopram was concluded to be more clinically effective and more cost-effective than
citalopram for the treatment of MDD, with a similar tolerability profile.