基线严重程度对焦虑障碍抗抑郁药疗效的影响：荟萃分析和荟萃回归。

Influence of baseline severity on antidepressant efficacy for anxiety disorders: meta-analysis and meta-regression.

机构信息

Ymkje Anna de Vries, MSc, Peter de Jonge, PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; Edwin van den Heuvel, PhD, Department of Mathematics and Computer Science, Technical University Eindhoven, Eindhoven, The Netherlands; Erick H. Turner, MD, Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, and Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA; Annelieke M. Roest, PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands

出版信息

Br J Psychiatry. 2016 Jun;208(6):515-21. doi: 10.1192/bjp.bp.115.173450. Epub 2016 Mar 17.

DOI:10.1192/bjp.bp.115.173450

PMID:26989093

Abstract

BACKGROUND

Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range.

AIMS

To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder.

METHOD

Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction.

RESULTS

Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI -0.13 to 0.20, P = 0.65) for GAD, -0.06 (95% CI -0.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI -0.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI -0.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI -0.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (β = 0.11, 95% CI 0.05 to 0.17, P = 0.001).

CONCLUSIONS

No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

摘要

背景

抗抑郁药是治疗焦虑症的一线药物，但它们在严重程度范围内的疗效是否相当尚不清楚。

目的

研究基线焦虑严重程度对广泛性焦虑障碍（GAD）、社交焦虑障碍（SAD）、强迫症（OCD）、创伤后应激障碍（PTSD）和惊恐障碍的抗抑郁药疗效的影响。

方法

纳入 56 项第二代抗抑郁药短期治疗焦虑障碍的试验。每个试验中均提取安慰剂和治疗组的基线和变化评分。采用混合效应元回归分析来研究治疗组、基线严重程度及其相互作用的影响。

结果

基线严重程度增加并不预示着药物组比安慰剂组有更大的改善。治疗组和基线严重程度之间交互项的标准化回归系数分别为：GAD 组为 0.04（95%CI-0.13 至 0.20，P=0.65），SAD 组为-0.06（95%CI-0.20 至 0.09，P=0.43），OCD 组为 0.04（95%CI-0.07 至 0.16，P=0.46），PTSD 组为 0.16（95%CI-0.22 至 0.53，P=0.37），惊恐障碍组为 0.002（95%CI-0.10 至 0.10，P=0.96）。对于 OCD，基线严重程度同样预测了安慰剂和药物组的改善（β=0.11，95%CI0.05 至 0.17，P=0.001）。