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To the Editor: We have some concerns regarding the randomized controlled trial by Dr Lenze and colleagues,¹ which investigated the efficacy of escitalopram for the treatment of generalized anxiety disorder (GAD) in older adults. First, it is not clear why the primary efficacy analysis was based on the Clinical Global Impression-Improvement scale. Patients were included based on a cutoff score on the Hamilton Anxiety Rating Scale, and change in score on this more specific scale is usually recommended as the primary outcome measure in studies of GAD.² Also, only weekly change in the Hamilton Anxiety Rating Scale was presented as a secondary outcome measure. Overall change from baseline to end point would have facilitated the interpretation of the results.

Second, it is not certain which patients were included in the primary outcome assessment of cumulative incidence of response. Based on the flow diagram in the article, it appears that all . . . [Full Text of this Article]

Sofie Schwan, MSc
sofie.schwan@lul.se
Uppsala County Council
Uppsala Drug Information Center

Pär Hallberg, MD, PhD
Department of Clinical Pharmacology
Uppsala University Hospital
Uppsala, Sweden

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RELATED ARTICLE

Escitalopram for Older Adults With Generalized Anxiety Disorder: A Randomized Controlled Trial
Eric J. Lenze, Bruce L. Rollman, M. Katherine Shear, Mary Amanda Dew, Bruce G. Pollock, Caroline Ciliberti, Michelle Costantino, Sara Snyder, Peichang Shi, Edward Spitznagel, Carmen Andreescu, Meryl A. Butters, and Charles F. Reynolds, III
JAMA. 2009;301(3):295-303.
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RELATED LETTER

Escitalopram Treatment of Generalized Anxiety Disorder in Older Adults—Reply
Eric J. Lenze
JAMA. 2009;301(19):1988.
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