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Paxil Study 329

           

 

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Paxil Study 329: Paroxetine vs Imipramine vs Placebo in Adolecents.

GlaxoSmithKline’s Study 329 of medication for adolescent depression failed to demonstrate any benefit for paroxetine over placebo in adolescents and demonstrated a worrying profile of adverse events for paroxetine.  The study was ultimately published in 2001 by the Journal of the American Academy of Child and Adolescent Psychiatry with Keller as the primary author. This misleading paper has been a focus of interest for Healthy Skepticism since 2002.  In 2003 we wrote to the Editor of JAACAP raising concerns about the misleading reporting by the authors that exaggerated benefit and downplayed adverse effects.  (We also questioned editorial functioning, which drew an angry response from the Editor).  In 2004 CMAJ published an Editorial which showed that in 1998 an internal GSK document clearly acknowledged that GSK were aware that 329 was negative.  A subsequent law suit by New York Attorney General, Eliot Spitzer, was settled out of court. 

In 2006, we wrote to the Lancet to point out that internal documents from another United States law suit (Smith versus GSK) revealed further concerns about study 329: -

           
  • The study was ghostwritten - see here.
  •        
  • Misleadingly positive interpretations of the study were promoted to drug reps and other GSK staff - see here.
  •        
  • An illusion of efficacy was achieved by re-inventing primary and secondary end points - see here.
  •        
  • Eventually GSK had to acknowledge the failure of all three of their child and adolescent paroxetine depression studies - see here.
  •      

Click here for Peter Mansfield’s summary of all trials of newer antidepressants in children and adolescents


Click here for J & E Jureidini’s summary of citations of the Keller paper

Documents from study 329

Jon Jureidini, Leemon McHenry and Peter Mansfield’s analysis of these documents is published as

Jureidini JN, McHenry LB, Mansfield PR.
    Clinical trials and drug promotion: Selective reporting of study 329
  International Journal of Risk and Safety in Medicine 2008 May;20(1-2):73-81
Link to source with long URL
   

DRAFTS/PEER REVIEWS

     
  1. Draft I. 18 Dec 1998
  2.  
  3. Draft ?II with ?Keller’s annotations. 11 Feb, 1999.
  4.  
  5. Draft III. 22 Mar, 1999.
  6.  
  7. Draft submitted to JAMA, 30 July 1999.
  8.  
  9. JAMA Reviews,    Oct 22, 1999
  10.  
  11. Response to JAMA reviews,  10 Dec, 1999. 
  12.  
  13. Draft VI, submitted to JAACAP, 25 Apr, 2000.
  14.  
  15. JAACAP Reviews
  16.  
  17. Response to JAACAP reviewers.
  18.  
  19. Response to Dulcan. 
  20.  
  21. Comparison of first to final draft

 

  POSTERS

     
  1. Keller M et al. American Psychiatric Association, Toronto, 2 Jun, 1998

  2. Wagner K et al. NCDEU. Boca Raton, Florida. 11 Jun, 1998.

  3. Berard R, Ryan N. European College of Neuropsychopharmacology, Paris, Oct 1998.

  4. Gagiono C. World Congress of Psychiatry, Hamburg, Oct, 1999.


LETTERS/ MEMOS/EMAILS/MINUTES

           
  1. Minutes:Teleconference.Paroxetine Study 329 Efficacy Analysis. 22 Apr, 1997
  2.        
  3. Top Line Results 21 Jan, 1998
  4.        
  5. Keller to Laden 11 Feb, 1999
  6.        
  7. Oakes to McCafferty 5 Mar, 1999
  8.        
  9. McCafferty to Laden 9 Mar, 1999
  10.        
  11. Clarke to Ryan 30 Mar, 1999
  12.        
  13. Klein to B. Ryan 15 Apr, 1999
  14.        
  15. Katz to Kline, 18 May, 1999
  16.        
  17. McCafferty to Laden, 19 Jul, 1999
  18.        
  19. McCafferty to Laden, 21 Jul, 1999
  20.        
  21. Laden to McCafferty 26 Apr 2000
  22.        
  23. Dulcan to Keller 27 Jul, 2000
  24.        
  25. Laden to Keller 4 Oct 2000
  26.        
  27. Laden to Brand et al, 11 Jan, 2001
  28.        
  29. Pretre to Keller, 6 Feb, 2001
  30.        
  31. White to Hood, 5 Mar, 2001
  32.        
  33. Battin to Laden, 27 Apr, 2001
  34.        
  35. Laden to McCafferty, 7 Aug, 2001
  36.        
  37. Hawkins to all sales representatives selling Paxil, Aug 16, 2001
  38.        
  39. Ryan to Keller and Strober, 4 Feb, 2004
  40.        
  41. Keller to Carpenter et al, 14 May, 2004
  42.        
  43. Keller to Ryan et al, 13 Jun, 2004        
  44.      



DEPOSITIONS

           
  1. McCafferty Deposition,  24-26 Aug, 2006
  2.        
  3. Ryan Deposition, 5 Oct, 2006
  4.        
  5. Oakes Deposition, 7 Nov, 2006        
  6.      


     

MEDICAL QUERIES/DEAR HEALTH CARE PROFESSIONAL LETTERS

           
  1. SKB Med Query. Jul, 1998
  2.        
  3. SKB Med Query. Jul, 1999
  4.        
  5. GSK Med Query. Jan, 2000
  6.        
  7. GSK Med Query. Sep, 2001
  8.        
  9. GSK Med Query. Feb, 2002
  10.        
  11. Dear Health Care Professional. Jul, 2003 (Canada)
  12.        
  13. Dear Health Care Professional. Jul, 2003
  14.        
  15. Dear Health Care Professional. May, 2004        
  16.      

     

INFORMATION FOR SALES REPRESENTATIVES

           
  1. SmithKline Beecham. Nulli Secundus. 8 Dec, 1999
  2.        
  3. GlaxoSmithKline. GSK Sales Connection. 10 Sep, 2003        
  4.      



OTHER

           
  1. Proposal: ‘Adolescent Unipolar Major Depression: Multisite Psychopharmacology Study’ Dec, 1992
  2.        
  3. Investigator Agreement, August, 1993
  4.        
  5. Position piece on the phase III clinical studies, 14 Oct, 1998
  6.        
  7. STI proposal for a journal article, 3 April, 1998
  8.        
  9. STI Release Form for JAACAP paper, 3 Nov, 2000
  10.        
  11. FDA Clinical Review, 2002
  12.        
  13. Statement of David Wheadon Sep 9, 2004
  14.      


       

 


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...to influence multinational corporations effectively, the efforts of governments will have to be complemented by others, notably the many voluntary organisations that have shown they can effectively represent society’s public-health interests…
A small group known as Healthy Skepticism; formerly the Medical Lobby for Appropriate Marketing) has consistently and insistently drawn the attention of producers to promotional malpractice, calling for (and often securing) correction. These organisations [Healthy Skepticism, Médecins Sans Frontières and Health Action International] are small, but they are capable; they bear malice towards no one, and they are inscrutably honest. If industry is indeed persuaded to face up to its social responsibilities in the coming years it may well be because of these associations and others like them.
- Dukes MN. Accountability of the pharmaceutical industry. Lancet. 2002 Nov 23; 360(9346)1682-4.