Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa.
Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, Universiteit Stellenbosch University, Cape Town, South Africa.
Acta Neuropsychiatr. 2020 Aug;32(4):169-176. doi: 10.1017/neu.2020.6. Epub 2020 Feb 10.
The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence.
The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD. We performed a standard pairwise meta-analysis using a random effects model and carried out a network meta-analysis (NMA) using the statistical package, R. Quality of evidence was also assessed.
We included 67 RCTs in the review and 21 to 45 interventions in the NMA. Paroxetine was most effective in the reduction of symptom severity as compared to placebo. Superior response to treatment was also observed for paroxetine, brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline. Higher dropout rates were found for fluvoxamine. Brofaromine, escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline, and venlafaxine performed worse in comparison to placebo for the outcome of dropouts due to adverse events. Olanzapine yielded a relatively high rank for treatment efficacy and buspirone the worse rank for dropouts due to any cause.
The differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine. We suggest paroxetine as a first-line treatment of SAD, with the consideration of future research on the drug olanzapine as well as brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline because we observed a response to treatment.
本文旨在对社交焦虑障碍（SAD）的药物治疗进行系统回顾和更新，包括这些药物的疗效和耐受性、干预措施的排名以及证据质量的分级。
在 Common Mental Disorder Controlled Trial Register 和两个试验注册库中搜索比较任何药物干预或安慰剂治疗 SAD 的随机对照试验（RCT）。我们使用随机效应模型进行标准的两两荟萃分析，并使用 R 统计包进行网络荟萃分析（NMA）。还评估了证据质量。
我们纳入了 67 项 RCT 和 NMA 中的 21-45 种干预措施。与安慰剂相比，帕罗西汀在减轻症状严重程度方面最有效。与安慰剂相比，还观察到帕罗西汀、布罗法罗明、溴马唑仑、氯硝西泮、依西酞普兰、氟伏沙明、苯乙肼和舍曲林的治疗反应更好。氟伏沙明的脱落率更高。布罗法罗明、依西酞普兰、氟伏沙明、帕罗西汀、普瑞巴林、舍曲林和文拉法辛在因不良反应导致脱落的结局方面表现不如安慰剂。奥氮平在治疗效果方面排名较高，而丁螺环酮在因任何原因导致脱落方面排名较低。
除了帕罗西汀在症状严重程度和反应方面有显著改善外，药物与安慰剂之间的差异较小。我们建议将帕罗西汀作为 SAD 的一线治疗药物，同时考虑对奥氮平以及布罗法罗明、溴马唑仑、氯硝西泮、依西酞普兰、氟伏沙明、苯乙肼和舍曲林进行进一步的研究，因为我们观察到了治疗反应。
