Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A network meta-analysis
Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A network meta-analysis
复制标题
成人广泛性焦虑症急性治疗一线药物的疗效和可接受性比较：网络荟萃分析
DOI：
10.1016/j.jpsychires.2019.08.009
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发表时间：
2019-11-01
影响因子：
4.8
通讯作者：
Ma, Xiancang
中科院分区：
文献类型：
--
作者：
He, Hairong;Xiang, Yutao;Ma, Xiancang
该指南推荐SSRI和SNRI药物作为广泛性焦虑症(GAD)的一线治疗药物。因此，我们的目标是通过比较一线药物的有效性和可接受性，使用网络荟萃分析来更新证据。检索相关电子数据库，检索1980年至2019年1月1日期间用于成人广泛性AD急性治疗的11种药物的安慰剂对照和正面试验。从每个符合条件的研究中提取有关人口统计学、临床和治疗信息的数据。主要结果是疗效(量化为汉密尔顿焦虑量表总分自基线以来的变化)和可接受性(量化为治疗因任何原因中断)。总体而言，41个随机对照研究的数据足以或适合纳入。在疗效方面，除氟西汀和伏替西汀外，其余药物均优于安慰剂，艾司匹兰的汉密尔顿焦虑量表评分的加权平均差为-3.2(95%可信区间[CRI]=-4.2~-2.2)，维拉唑酮的加权平均差为-1.8(95%CRI=-3.1~-0.55)。在可接受性方面，只有维拉唑酮(OR=1.7，95%CRI=1.1~2.7)比安慰剂差，其他组与安慰剂没有显著差异。在面对面比较中，伏替西汀表现出较好的可接受性和耐受性，但疗效和有效率较差。总而言之，大多数药物比安慰剂更有效，活性药物和安慰剂在可接受性方面几乎没有显著差异。总体而言，度洛西汀和艾司匹兰的疗效较好，伏替西汀的可接受性较好。
The guide recommends SSRI and SNRI drugs as first-line treatments for generalized anxiety disorder (GAD). Therefore, we aimed to update the evidence using network meta-analysis by comparing the efficacy and acceptability of first-line drugs. The relevant electronic databases were searched for placebo-controlled and headto-head trials of 11 drugs used for the acute treatment of adults with GAD from 1980 up to January 1, 2019. Data on demographics, clinical, and treatment information were extracted from each eligible study. The primary outcomes were efficacy (quantified as the change in the total score on the Hamilton Anxiety Scale from baseline) and acceptability (quantified as treatment discontinuations due to any cause). Overall, the data on 41 RCTs were sufficient or appropriate for inclusion. In terms of efficacy, all of the drugs except fluoxetine and vortioxetine were more effective than placebo, with the weighted mean difference of the Hamilton Anxiety Scale score ranging between - 3.2 (95% credible interval [CrI] = - 4.2 to - 2.2) for escitalopram and -1.8 (95% CrI = - 3.1 to - 0.55) for vilazodone. For acceptability, only vilazodone (OR = 1.7, 95% CrI = 1.1 to 2.7) were worse than placebo, others did not show significant differences from placebo. In head-to-head comparisons, vortioxetine showed better acceptability and tolerability but worse efficacy and response rate. In conclusion, most drugs are more effective than placebo, and there are few significant differences between the active drugs and placebo on acceptability. Overall, duloxetine and escitalopram showed better efficacy while vortioxetine showed better acceptability.