Li Xinyuan, Hou Yanbo, Su Yingying, Liu Hongping, Zhang Beilin, Fang Shaokuan
Department of Neurology, Neuroscience Centre, The First Teaching Hospital of Jilin University, Changchun, P.R. China.
School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Medicine (Baltimore). 2020 Apr;99(14):e19573. doi: 10.1097/MD.0000000000019573.
The present study aimed to estimate the comprehensive efficacy and tolerability of paroxetine in adult patients with social anxiety disorder (SAD).
We conducted a comprehensive literature review of the PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials databases for eligible randomized controlled trials (RCTs). The efficacy outcome was the mean change of different kinds of scale scores as well as response and remission rates. The secondary outcome was tolerability, defined as the discontinuation rate and the incidence of adverse events (AEs).
Our meta-analysis included 13 RCTs. Mean changes in the Liebowitz Social Anxiety Scale (LSAS) total score, fear and avoidance subscale of LSAS scores were all significantly greater in patients with SAD that received paroxetine compared to those received placebo (total: MD = 13.46, 95%CI 10.59-16.32, P < .00001; fear: MD = 6.76, 95%CI 4.89-8.62, P < .00001; avoidance: MD = 6.54, 95%CI 4.63-8.45, P < .00001). Response and remission rates were both significantly greater in patients with SAD that received paroxetine compared to those received placebo (response: OR = 3.02, 95%CI 2.30-3.97, P < .00001; remission: OR = 3.14, 95%CI 2.25-4.39, P < .00001). There was no significant difference in discontinuation rate due to any reason between two groups (OR = 1.06, 95%CI 0.81-1.39, P = .65). Discontinuation rate due to AEs was higher in paroxetine than placebo group (OR = 3.41, 95%CI 2.45-4.72, P < .00001) whereas the rate due to lack of efficacy was higher in placebo as compared with paroxetine group (OR = 0.14, 95%CI 0.09-0.22, P < .00001). The incidence of any AE was significantly increased in patients that received paroxetine (OR = 1.83, 95%CI 1.43-2.35, P < .00001).
Paroxetine was an effective and well-tolerated treatment option for adult patients with SAD.
本研究旨在评估帕罗西汀对成年社交焦虑障碍（SAD）患者的综合疗效及耐受性。
我们对PubMed、Embase、Cochrane对照试验中央注册库、Web of Science及ClinicalTrials数据库进行了全面的文献检索，以查找符合条件的随机对照试验（RCT）。疗效指标为各类量表评分的平均变化以及有效率和缓解率。次要指标为耐受性，定义为停药率及不良事件（AE）发生率。
我们的荟萃分析纳入了13项RCT。与接受安慰剂的SAD患者相比，接受帕罗西汀治疗的患者在利伯维茨社交焦虑量表（LSAS）总分、LSAS恐惧和回避分量表评分的平均变化均显著更大（总分：MD = 13.46，95%CI 10.59 - 16.32，P <.00001；恐惧：MD = 6.76，95%CI 4.89 - 8.62，P <.00001；回避：MD = 6.54，95%CI 4.63 - 8.45，P <.00001）。与接受安慰剂的SAD患者相比，接受帕罗西汀治疗的患者有效率和缓解率均显著更高（有效率：OR = 3.02，95%CI 2.30 - 3.97，P <.00001；缓解率：OR = 3.14，95%CI 2.25 - 4.39，P <.00001）。两组因任何原因导致的停药率无显著差异（OR = 1.06，95%CI 0.81 - 1.39，P =.65）。帕罗西汀组因AE导致的停药率高于安慰剂组（OR = 3.41，95%CI 2.45 - 4.72，P <.00001），而安慰剂组因疗效不佳导致的停药率高于帕罗西汀组（OR = 0.14，95%CI 0.09 - 0.22，P <.00001）。接受帕罗西汀治疗的患者任何AE的发生率显著增加（OR = 1.83，95%CI 1.43 - 2.35，P <.00001）。
帕罗西汀是成年SAD患者一种有效且耐受性良好的治疗选择。
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