Table II.
GRADE Summary of findings: effect of citalopram on QT interval in adults with mental disorders
| Outcome | Risk with intervention per 1000 | Risk with comparator per 1000 | Relative measure of association | No. of participants (studies) | Quality (GRADE) | Comments† |
|---|---|---|---|---|---|---|
| QTc > 30 ms, 3 weeks | 74 | 11 | RR = 6.85 (0.86–54.59) | 186 (1 RCT) [96] | Very low | No difference |
| QTc > 60 ms | 33 | 0 | RR = 3.19 (0.14–75.49) | 62 (1 RCT) [107] | Very low | No difference |
| QTc > 450 ms for men or > 470 ms for women, 3 weeks | 32 | 11 | RR = 2.94 (0.31–27.71) | 186 (1 RCT) [96] | Very low | No difference |
| QTc > 500 ms | 0 | 0 | RR inestimable | 62 (1 RCT) [107] | Very low | No difference |
| QTC [ms] | NR | NR | MD = 6.56 (0.07–13.04) | 892 (6 RCTs) [7, 71, 94, 96, 107] | Moderate | Favors control |
| QTc ≥ 450 ms, adults with predialysis CKD | NR | NR | Adjusted OR = 1.80 (1.00–3.10) | 3252 (1 observational study) [112] | Low | Favors control |
| QT prolongation | NR | NR | Adjusted MD = 0.10 (0.02–0.18) | 38397 (1 observational study) [86] | Low | Favors control |
| QT prolongation | NR | NR | Adjusted OR = 4.38 (1.45–13.30) | 6790 (1 observational study) [87] | Low | Favors control |
| Sudden death with cardiovascular disease | NR | NR | Adjusted OR = 1.81 (0.81–4.03) | 4040 (1 observational study) [76] | Low | No difference |
| Sudden death without cardiovascular disease | NR | NR | Adjusted OR = 1.70 (0.50–5.99) | 4040 (1 observational study) [76] | Low | No difference |
Population: adults with mental disorders, Settings: any, Intervention: citalopram, any dose, Comparator: placebo or no active drug. Boldface indicates statistically significant differences at 95% CI. †We concluded that there is no difference in outcomes between active and control interventions based on p-value > 0.05 and inability to reject null hypotheses but without post hoc analysis of the statistical power to detect true differences. GRADE – Grading of Recommendations Assessment, Development and Evaluation, NR – not reported, OR – odds ratio, RCT – randomized controlled trial, RR – relative risk. Between studies differences in continuous outcomes: MD – mean difference in absolute values of continuous outcomes between intervention and comparator, SMD – standardized mean difference between intervention and comparator where the magnitude of the effect is defined as small (SMD, 0–0.5 standard deviations), moderate (SMD, 0.5–0.8 standard deviations), and large (SMD > 0.8 standard deviations).