Department of Neurosurgery, University Hospital Center Zagreb, Zagreb University School of Medicine, Zagreb, Croatia.
Center for Palliative Medicine, Medical Ethics and Communication Skills (CEPAMET), Zagreb University School of Medicine, Zagreb, Croatia.
Adv Ther. 2018 Mar;35(3):261-288. doi: 10.1007/s12325-018-0680-6. Epub 2018 Mar 5.
The objective was to evaluate efficacy/safety of complementary and alternative medicine (CAM) methods for generalized anxiety disorder (GAD) based on randomized controlled trials in adults.
Data sources. Six electronic databases ("generalized anxiety (disorder)" and "randomized trial") and reference lists of identified publications were searched to March 2017.
Eligibility: full-text publications (English, German language); CAM versus conventional treatment, placebo/sham or no treatment; GAD diagnosed according to standard criteria; and a validated scale for disease severity. Of the 6693 screened records, 32 were included (18 on biologically-based therapies, exclusively herbal preparations; eight on manipulative and body-based therapies; and three on alternative medical systems and three on mind-body therapies).
Cochrane Collaboration methodology was used for quality assessment and data extraction.
Direct comparisons of Kava Kava (Piper methysticum) extracts to placebo (4 quality trials, n = 233) were highly heterogeneous. Network meta-regression reduced heterogeneity and suggested a modest Kava effect [end-of-treatment Hamilton Anxiety scale score difference adjusted for baseline scores and trial duration: - 3.24 (95% CI - 6.65, 0.17; P = 0.059), Kava Kava 4 arms, n = 139; placebo 5 arms, n = 359]. Lavender (Lavandula angustifolia) extract (1 quality trial, 10 weeks, n = 523) and a combination of extracts of C. oxycantha, E. californica and magnesium (1 quality trial, 12 weeks, n = 264) were superior to placebo and balneotherapy was superior to paroxetine (1 quality trial, 8 weeks, n = 237) indicating efficacy. All other trials were small and/or of modest/low quality and/or lacked assay sensitivity. Safety reporting was poor.
Evidence about efficacy/safety of most CAM methods in GAD is limited. Apparent efficacy of certain herbal preparations and body-based therapies requires further confirmation.
本研究旨在评估成人广泛性焦虑障碍（GAD）的补充和替代医学（CAM）方法的疗效/安全性，纳入了随机对照试验。
数据来源。检索了六个电子数据库（“广泛性焦虑（障碍）”和“随机试验”）和已确定出版物的参考文献列表，检索时间截至 2017 年 3 月。
入选标准：全文出版物（英文、德文）；CAM 与常规治疗、安慰剂/假治疗或无治疗相比；根据标准标准诊断为 GAD；以及疾病严重程度的有效量表。在筛选的 6693 条记录中，有 32 条符合条件（18 条为基于生物的疗法，仅草药制剂；8 条为手法和身体为基础的疗法；3 条为替代医疗系统，3 条为身心疗法）。
使用 Cochrane 协作方法进行质量评估和数据提取。
与安慰剂相比，Kava Kava（Piper methysticum）提取物的直接比较（4 项质量试验，n=233）高度异质。网络荟萃回归减少了异质性，并表明 Kava 有适度的效果[治疗结束时汉密尔顿焦虑量表评分差异，调整基线评分和试验持续时间：-3.24（95%CI-6.65，0.17；P=0.059），Kava Kava 4 个组，n=139；安慰剂 5 个组，n=359]。薰衣草（Lavandula angustifolia）提取物（1 项质量试验，10 周，n=523）和 C. oxycantha、E. californica 和镁的提取物组合（1 项质量试验，12 周，n=264）优于安慰剂，水疗优于帕罗西汀（1 项质量试验，8 周，n=237），表明有效。所有其他试验规模较小，质量较低，或缺乏检测敏感性。安全性报告不佳。
关于 GAD 中大多数 CAM 方法的疗效/安全性的证据有限。某些草药制剂和身体为基础的疗法的明显疗效需要进一步证实。
