抗焦虑药物治疗焦虑症的比较疗效和可接受性:一项系统综述和网络荟萃分析。

IF 3.7 3区 医学 Q1 CLINICAL NEUROLOGY
Thomas J Müller, Arnaud Künzi, Ellen Heitlinger, Bernd Krämer, Roland von Känel, Josef Hättenschwiler, Matthias Hilpert, Christian Imboden, Edith Holsboer-Trachsler, Martin Hatzinger, Siegfried Kasper, Borwin Bandelow, Erich Seifritz
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引用次数: 0

摘要

背景:抗焦虑药物的副作用和依赖风险需要在做出治疗决定时充分考虑其疗效和可接受性。方法:对1980年至2020年的三个数据库进行系统回顾和网络荟萃分析(NMA),重点关注被诊断为广泛性焦虑症(GAD)或任何相关焦虑症诊断分类或汉密尔顿焦虑症(HAM-A)数据可用的成年人,并包括任何比较物(安慰剂和/或积极比较物治疗)。主要结局是疗效(HAM-A总分与基线变化的平均差异)和可接受性(任何原因导致的研究中断)。本研究已在Open Science Framework (OSF)数据库注册。研究结果:对涉及28,637名参与者的100项试验的分析表明,大多数活性药物在减少焦虑方面比安慰剂更有效。值得注意的是,silexan是唯一被列入NMA的植物药。氯丙咪嗪的疗效最高,沃替西汀的疗效最低。然而,在可接受性方面,氯丙咪嗪导致的研究中断率最高,而氯巴嗪的停药率最低,这表明疗效和可接受性并不总是一致的。值得注意的是,silexan既高效又与安慰剂一样可接受。只有四种治疗方法的不良事件少于安慰剂(地西泮、阿戈美拉汀、氯巴赞和西列森)。结论:该网络荟萃分析提供了抗焦虑药的疗效和可接受性的独特比较。它代表了最全面的证据基础之一,可用于指导成人焦虑症的首选治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative efficacy and acceptability of anxiolytic drugs for the treatment of anxiety disorders: a systematic review and network meta-analysis.

Background: Anti-anxiety medications' side effects and dependency risks necessitate thorough consideration of their efficacy and acceptability when making treatment decisions.

Methods: A systematic review and Network Meta-Analysis (NMA) was conducted using three databases from 1980 to 2020, focusing on adults diagnosed with generalized anxiety disorder (GAD) or any relevant diagnostic classification of anxiety disorder or those for whom Hamilton Anxiety (HAM-A) data is available, and including any comparator (placebo and/or active comparator treatments). The primary outcomes were efficacy (mean difference in change from baseline in HAM-A total score) and acceptability (study discontinuations for any cause). This study is registered with Open Science Framework (OSF) database.

Findings: Analysis of 100 trials involving 28,637 participants showed that most active drugs were more effective than placebo in reducing anxiety. Notably, silexan was the only phytopharmaceutical included in the NMA. Clomipramine had the highest efficacy and vortioxetine the least. However, in terms of acceptability, clomipramine led to the most study discontinuations, while clobazam had the lowest discontinuation rate, indicating that efficacy and acceptability do not always align. Notably, silexan was both highly effective and as acceptable as a placebo. Only four treatments showed fewer adverse events than placebo (diazepam, agomelatine, clobazam, and silexan).

Conclusion: This network meta-analysis provides a unique comparison of the efficacy and acceptability of anxiolytics. It represents one of the most comprehensive evidence bases available to guide the first choice of treatment for anxiety disorders in adults.

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来源期刊
CiteScore
8.80
自引率
4.30%
发文量
154
审稿时长
6-12 weeks
期刊介绍: The original papers published in the European Archives of Psychiatry and Clinical Neuroscience deal with all aspects of psychiatry and related clinical neuroscience. Clinical psychiatry, psychopathology, epidemiology as well as brain imaging, neuropathological, neurophysiological, neurochemical and moleculargenetic studies of psychiatric disorders are among the topics covered. Thus both the clinician and the neuroscientist are provided with a handy source of information on important scientific developments.
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