Levitan Michelle Nigri, Papelbaum Marcelo, Nardi Antonio Egidio
Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ; State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, Brazil.
Neuropsychiatr Dis Treat. 2015 May 5;11:1149-55. doi: 10.2147/NDT.S67470. eCollection 2015.
Although many generalized anxiety disorder (GAD) patients respond to the available pharmacological treatments, nearly half of them do not present the expected results. Besides, the side effects associated to some drugs have a negative impact on treatment adherence. Therefore, the aim of this review was to report the clinical profile of agomelatine, a selective melatonergic MT1/MT2 receptor agonist with serotonin 5-HT2c receptor antagonist activities, as a potential pharmacological option in the treatment of GAD.
We performed a literature review regarding studies that evaluated the use of agomelatine in GAD treatment.
Two short-term, double-blinded studies and one prevention-treatment trial evaluated the efficacy of agomelatine in the treatment of GAD. Agomelatine was associated with higher rates of clinical response and remission, when compared to placebo. In addition, the long-term use of agomelatine decreased the risk of relapse of anxiety symptoms, even for the severely ill patients. Besides, the tolerability was satisfactory with the absence of discontinuation symptoms, as observed in previous studies.
The efficacy and tolerability profiles of agomelatine in the treatment of GAD were good. However, the scarce number of trials, the small sample sizes, and the use of patients without any comorbid conditions were some limitations that impaired the generalization of the results in the general population. Nevertheless, agomelatine is an attractive off-label option in the treatment of GAD that needs more conclusive evidences to establish its role in future guidelines.
尽管许多广泛性焦虑症（GAD）患者对现有的药物治疗有反应，但近一半患者未呈现预期疗效。此外，某些药物的副作用对治疗依从性有负面影响。因此，本综述旨在报告阿戈美拉汀的临床概况，阿戈美拉汀是一种具有5-羟色胺5-HT2c受体拮抗剂活性的选择性褪黑素能MT1/MT2受体激动剂，作为治疗GAD的一种潜在药物选择。
我们对评估阿戈美拉汀在GAD治疗中应用的研究进行了文献综述。
两项短期双盲研究和一项预防-治疗试验评估了阿戈美拉汀治疗GAD的疗效。与安慰剂相比，阿戈美拉汀的临床反应和缓解率更高。此外，即使对重症患者，长期使用阿戈美拉汀也降低了焦虑症状复发的风险。此外，如先前研究中所观察到的，耐受性良好，无停药症状。
阿戈美拉汀治疗GAD的疗效和耐受性良好。然而，试验数量稀少、样本量小以及使用无任何合并症的患者是一些限制因素，影响了研究结果在一般人群中的推广。尽管如此，阿戈美拉汀是治疗GAD的一个有吸引力的超说明书用药选择，需要更多确凿证据来确定其在未来指南中的作用。
