Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis.
Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis.
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选择性5-羟色胺再摄取抑制剂、5-羟色胺和去甲肾上腺素再摄取抑制剂治疗焦虑、强迫症和应激障碍：一项3级网络荟萃分析
DOI：
10.1371/journal.pmed.1003664
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发表时间：
2021-06
期刊：
影响因子：
15.8
通讯作者：
Salum GA
中科院分区：
文献类型：
--
作者：
Gosmann NP;Costa MA;Jaeger MB;Motta LS;Frozi J;Spanemberg L;Manfro GG;Cuijpers P;Pine DS;Salum GA
焦虑、强迫症和压力相关疾病经常同时出现，患者通常会出现多个方面的症状。治疗包括使用选择性血清素再摄取抑制剂（SSRI）以及血清素和去甲肾上腺素再摄取抑制剂（SNRI），但缺乏比较疗效和可接受性的数据。我们的目的是通过三级网络荟萃分析，比较 SSRIs、SNRIs 和安慰剂在一生中患有这些诊断的患者的多个症状领域的疗效。我们在MEDLINE、PsycINFO、Embase和Cochrane图书馆中检索了已发表和未发表的随机对照试验，这些试验旨在评估SSRIs或SNRIs对诊断为任何焦虑、强迫或压力相关障碍的参与者（成人和儿童）的疗效，从开始到2015年4月23日，更新于2020年11月11日。我们通过手动搜索补充了电子数据库搜索在可公开访问的临床试验注册中心和制药公司数据库中注册的已发表和未发表的随机对照试验。对于任何其他精神障碍的合并症、参与者的年龄和性别、参与者和研究人员的致盲、出版日期或研究语言没有做出限制。主要结果是这些疾病的内化症状的总体测量。次要结果包括特定症状范围和治疗中断率。我们通过药物和评估工具的研究，通过具有随机斜率的三级网络荟萃分析来估计标准化平均差（SMD）。使用 Cochrane 协作组织的偏倚风险工具进行偏倚风险评估。这项研究已在 PROSPERO 中注册（CRD42017069090）。我们分析了 135 项研究的 469 项结果指标 (n = 30,245)。对于所有症状领域以及所有诊断类别的患者，所有药物在内化症状的总体测量方面都比安慰剂更有效（SMD -0.56，95% CI -0.62 至 -0.51，p < 0.001）。当限制每次诊断最常用的评估工具时，我们还发现了显着的结果；然而，这一限制导致 72.71% 的结果指标被排除在外。成对比较显示药物之间在疗效和可接受性方面只有很小的差异。局限性包括大多数结果中发现的中等异质性以及大多数试验中发现的中等偏倚风险。在这项研究中，我们观察到所有 SSRI 和 SNRI 对多个症状领域以及所有包含的诊断类别的患者均有效。我们发现药物之间在功效和可接受性方面的差异很小。考虑到与之前的研究相比，数据量明显更大，统计功效更高，这种三级网络荟萃分析有助于以强有力的证据继续讨论抗抑郁药的真正益处。三级方法使我们能够正确评估这些药物对内化精神病理学的疗效，避免因不同评估工具而排除信息而产生的潜在偏差，并探索跨诊断疗效的多级结构。在一项随机试验的荟萃分析中，Natan Pereira Gosmann 及其同事研究了 SSRI 和 SNRI 对焦虑、强迫和压力相关疾病症状的功效。评估焦虑、强迫和压力相关疾病患者的合并症的研究报告显示，合并症的发生率超过 50%，并且患者通常会出现多个症状领域的症状。据我们所知，选择性血清素再摄取抑制剂（SSRIs）以及血清素和去甲肾上腺素再摄取抑制剂（SNRIs）对多个心理健康领域的功效尚未通过该领域的网络荟萃分析进行研究。荟萃分析通常将统计分析限制在最常用的评估工具上。我们对 469 项结果指标进行了系统回顾和三级网络荟萃分析，包括与焦虑、强迫症和压力相关疾病相关的所有可用结果指标。 SSRIs 和 SNRIs 对所有诊断类别的参与者的心理健康的整体改善表现出小到中等的效果。我们还发现，我们的敏感性分析中的效应大小仅限于最常用的评估工具；然而，这一限制导致 72.71% 的结果指标被排除在外。我们的结果支持了先前与 SSRI 和 SNRI 功效相关的研究结果，表明这些药物在多个健康领域有效。这项研究改进了 SSRI 和 SNRI 对焦虑症有益的证据。这些结果应该指导精神科医生、患者、临床医生和政策制定者为这些疾病的初始治疗做出更好的基于证据的决策。
Anxiety, obsessive-compulsive, and stress-related disorders frequently co-occur, and patients often present symptoms of several domains. Treatment involves the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), but data on comparative efficacy and acceptability are lacking. We aimed to compare the efficacy of SSRIs, SNRIs, and placebo in multiple symptom domains in patients with these diagnoses over the lifespan through a 3-level network meta-analysis. We searched for published and unpublished randomized controlled trials that aimed to assess the efficacy of SSRIs or SNRIs in participants (adults and children) with diagnosis of any anxiety, obsessive-compulsive, or stress-related disorder in MEDLINE, PsycINFO, Embase, and Cochrane Library from inception to 23 April 2015, with an update on 11 November 2020. We supplemented electronic database searches with manual searches for published and unpublished randomized controlled trials registered in publicly accessible clinical trial registries and pharmaceutical companies’ databases. No restriction was made regarding comorbidities with any other mental disorder, participants’ age and sex, blinding of participants and researchers, date of publication, or study language. The primary outcome was the aggregate measure of internalizing symptoms of these disorders. Secondary outcomes included specific symptom domains and treatment discontinuation rate. We estimated standardized mean differences (SMDs) with 3-level network meta-analysis with random slopes by study for medication and assessment instrument. Risk of bias appraisal was performed using the Cochrane Collaboration’s risk of bias tool. This study was registered in PROSPERO (CRD42017069090). We analyzed 469 outcome measures from 135 studies (n = 30,245). All medications were more effective than placebo for the aggregate measure of internalizing symptoms (SMD −0.56, 95% CI −0.62 to −0.51, p < 0.001), for all symptom domains, and in patients from all diagnostic categories. We also found significant results when restricting to the most used assessment instrument for each diagnosis; nevertheless, this restriction led to exclusion of 72.71% of outcome measures. Pairwise comparisons revealed only small differences between medications in efficacy and acceptability. Limitations include the moderate heterogeneity found in most outcomes and the moderate risk of bias identified in most of the trials. In this study, we observed that all SSRIs and SNRIs were effective for multiple symptom domains, and in patients from all included diagnostic categories. We found minimal differences between medications concerning efficacy and acceptability. This three-level network meta-analysis contributes to an ongoing discussion about the true benefit of antidepressants with robust evidence, considering the significantly larger quantity of data and higher statistical power when compared to previous studies. The 3-level approach allowed us to properly assess the efficacy of these medications on internalizing psychopathology, avoiding potential biases related to the exclusion of information due to distinct assessment instruments, and to explore the multilevel structure of transdiagnostic efficacy. In a meta-analysis of randomized trials, Natan Pereira Gosmann and colleagues study efficacy of SSRIs and SNRIs for symptoms of anxiety, obsessive-compulsive, and stress-related disorders. Studies assessing comorbidity in patients with anxiety, obsessive-compulsive, and stress-related disorders report rates above 50%, and patients often present symptoms of multiple symptom domains. The efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) on multiple mental health domains has not yet been studied by network meta-analysis in this field, to the best of our knowledge. Meta-analyses often restrain the statistical analysis to the most commonly used assessment instruments. We conducted a systematic review and 3-level network meta-analysis of 469 outcome measures, including all available measures of outcomes related to anxiety, obsessive-compulsive, and stress-related disorders. SSRIs and SNRIs presented small to moderate effect sizes for global improvement of mental health in participants from all diagnostic categories. We also found small to moderate effect sizes in our sensitivity analysis restricted to the most used assessment instruments; however, this restriction led to the exclusion of 72.71% of all outcome measures. Our results support previous findings related to the efficacy of SSRIs and SNRIs indicating that these medications are effective in multiple health domains. This study improved the evidence of the benefit of SSRIs and SNRIs for anxiety disorders. These results should guide psychiatrists, patients, clinicians, and policy makers on better evidence-based decisions for the initial treatment of these disorders.
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影响因子：
2.9
作者：
Furukawa TA;Salanti G;Atkinson LZ;Leucht S;Ruhe HG;Turner EH;Chaimani A;Ogawa Y;Takeshima N;Hayasaka Y;Imai H;Shinohara K;Suganuma A;Watanabe N;Stockton S;Geddes JR;Cipriani A
通讯作者：
Cipriani A
影响因子：
7.4
作者：
Alonso J;Liu Z;Evans-Lacko S;Sadikova E;Sampson N;Chatterji S;Abdulmalik J;Aguilar-Gaxiola S;Al-Hamzawi A;Andrade LH;Bruffaerts R;Cardoso G;Cia A;Florescu S;de Girolamo G;Gureje O;Haro JM;He Y;de Jonge P;Karam EG;Kawakami N;Kovess-Masfety V;Lee S;Levinson D;Medina-Mora ME;Navarro-Mateu F;Pennell BE;Piazza M;Posada-Villa J;Ten Have M;Zarkov Z;Kessler RC;Thornicroft G;WHO World Mental Health Survey Collaborators
通讯作者：
WHO World Mental Health Survey Collaborators
影响因子：
8.1
作者：
Cuijpers, P.;Weitz, E.;Twisk, J.
通讯作者：
Twisk, J.
DOI：
10.1176/appi.focus.16407
发表时间：
2018-10-01
期刊：
Focus (American Psychiatric Publishing)
影响因子：
--
作者：
Cipriani, Andrea;Furukawa, Toshi A;Geddes, John R
通讯作者：
Geddes, John R
影响因子：
39.2
作者：
Hutton, Brian;Salanti, Georgia;Moher, David
通讯作者：
Moher, David