Du Yang, Du Biao, Diao Yun, Yin Zubin, Li Jin, Shu Yunfeng, Zhang Zizhen, Chen Lizhi
Department of Psychosomatic Medicine, The Affiliated Three Gorges Hospital of Chongqing University, Chongqing, 404000, China.
Department of Pharmacy, The Affiliated Three Gorges Hospital of Chongqing University, Chongqing, 404000, China.
Asian J Psychiatr. 2021 Jun;60:102664. doi: 10.1016/j.ajp.2021.102664. Epub 2021 May 3.
This systematic review aims to assess the efficacy and acceptability of the different types of antidepressants and benzodiazepines for the treatment of panic disorder (PD) in adult patients.
PubMed, Web of Science, EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) published between 1995 and 2020 on the use of antidepressants and benzodiazepines for the treatment of PD. A systematic review and network meta-analysis were performed.
42 RCTs were included in the network meta-analysis, with a comparison of 11 interventions.Escitalopram (odds ratios OR 1.52, 95 % credible interval CI 1.09-2.10), venlafaxine (OR 1.33, 95 % CI 1.16-1.51) and benzodiazepines (OR 1.50, 95 % CI 1.29-1.75) had greater efficacy and acceptability than the placebo. Imipramine(OR 1.43, 95 % CI 1.15-1.79) was also demonstrated to be efficacious and tolerated but the results were restricted to small sample size. Moreover, paroxetine, sertraline, fluoxetine, citalopram and clomipramine (OR 1.37, 1.36, 1.45, 1.33 and 1.36, respectively) were more efficacious, although the acceptability of paroxetine and sertraline were significantly less tolerated than benzodiazepines. Notably, the efficacy of reboxetine and fluvoxamine were merely as equal as that of the placebo.
This is the first systematic review of antidepressants and benzodiazepines for the treatment of PD to use a network analysis. Escitalopram and venlafaxine as well as benzodiazepines may be effective choices as treatments for PD with relatively good acceptability, which still needs to be confirmed byhigh-quality RCTs.
本系统评价旨在评估不同类型的抗抑郁药和苯二氮䓬类药物治疗成年惊恐障碍（PD）患者的疗效和可接受性。
检索了PubMed、科学网、EMBASE、MEDLINE、Cochrane图书馆和ClinicalTrials.gov，查找1995年至2020年期间发表的关于使用抗抑郁药和苯二氮䓬类药物治疗PD的随机对照试验（RCT）。进行了系统评价和网状Meta分析。
网状Meta分析纳入了42项RCT，比较了11种干预措施。艾司西酞普兰（优势比OR 1.52，95%可信区间CI 1.09 - 2.10）、文拉法辛（OR 1.33，95% CI 1.16 - 1.51）和苯二氮䓬类药物（OR 1.50，95% CI 1.29 - 1.75）比安慰剂具有更高的疗效和可接受性。丙咪嗪（OR 1.43，95% CI 1.15 - 1.79）也被证明有效且耐受性良好，但结果限于小样本量。此外，帕罗西汀、舍曲林、氟西汀、西酞普兰和氯米帕明（分别为OR 1.37、1.36、1.45、1.33和1.36）更有效，尽管帕罗西汀和舍曲林的可接受性明显低于苯二氮䓬类药物。值得注意的是，瑞波西汀和氟伏沙明的疗效仅与安慰剂相当。
这是首次使用网状分析对治疗PD的抗抑郁药和苯二氮䓬类药物进行的系统评价。艾司西酞普兰、文拉法辛以及苯二氮䓬类药物可能是治疗PD的有效选择，且具有相对较好的可接受性，这仍需高质量RCT予以证实。
