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坦度螺酮治疗广泛性焦虑障碍的临床结局的早期结果、相关因素及预测价值:一项随机、对照、多中心临床试验的事后分析。

Early outcomes, associated factors and predictive values of clinical outcomes of tandospirone in generalized anxiety disorder: a post-hoc analysis of a randomized, controlled, multicenter clinical trial.

机构信息

Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, P.R. China.

Zhongshan Hospital, Fudan University, Shanghai, P.R. China.

出版信息

Curr Med Res Opin. 2023 Apr;39(4):597-603. doi: 10.1080/03007995.2023.2175998. Epub 2023 Feb 26.

Abstract

OBJECTIVE

To examine the early outcomes, associated factors and predictive values of clinical outcomes of different tandospirone doses in patients with a generalized anxiety disorder (GAD).

METHODS

This was a posthoc analysis of "a randomized, controlled multicenter clinical trial of the efficacy and safety of different doses of tandospirone on GAD". A total of 274 patients with GAD were included and randomized into the high-dose (tandospirone 60 mg/d) and low-dose (tandospirone 30 mg/d) groups for a 6-week treatment. The Hamilton Anxiety (HAMA), Clinical Global Impression-Severity (CGI-S), Short-Form-12 (SF-12) scales were used for assessment. The trial was registered at clinical trail.gov (NCT01614041).

RESULTS

(1) In the first week of treatment, 35.8% of patients in the high-dose group fulfilled the early onset criteria, which was significantly higher than 19.0% found in the low-dose group ( = 0.002). In the second week of treatment, 22.6% of patients in the high-dose group achieved an early response, versus 12.4% in the low-dose group, indicating a significant difference ( = .026). (2) Factors associated with early onset at week 1 included baseline HAMA total score (OR = 0.916, 95%CI 0.882-0.952), age (OR = 0.974, 95%CI 0.950-0.998), drug dose (30 mg vs. 60 mg; OR = 0.298, 95%CI 0.156-0.568) and SF-12 physiological total score (OR = 1.030, 95%CI 1.010-1.050). (3) Early onset was significantly associated with response rate (OR = 18.34, 95%CI 12.10-27.81), remarkable response rate (OR = 27.56, 95%CI 11.65-65.17) and recovery rate (OR = 11.85, 95%CI 4.98-28.18). Group (high dose group vs. low dose group) ( = 8.535,  = .003) and baseline HAMA total score ( = 70.840,  < .001) were independent predictors of onset time.

CONCLUSIONS

The early outcomes of high-dose tandospirone in the treatment of GAD are better than those of the low-dose group. Patients with younger age at onset, milder anxiety symptoms and better physiological functions administered high-dose tandospirone showed rapid onset, great early outcomes, high recovery rate and good prognosis. Drug onset time had a good predictive effect on treatment outcome.

摘要

目的

探讨广泛性焦虑障碍(GAD)患者应用不同剂量坦度螺酮的早期结局、相关因素及其对临床结局的预测价值。

方法

这是一项“不同剂量坦度螺酮治疗 GAD 的疗效和安全性的随机、对照、多中心临床试验”的事后分析。共纳入 274 例 GAD 患者,随机分为高剂量(坦度螺酮 60mg/d)和低剂量(坦度螺酮 30mg/d)组,治疗 6 周。采用汉密尔顿焦虑量表(HAMA)、临床总体印象严重度量表(CGI-S)、SF-12 量表进行评估。试验在 clinicaltrail.gov 注册(NCT01614041)。

结果

(1)治疗第 1 周,高剂量组 35.8%的患者符合早期发作标准,明显高于低剂量组的 19.0%( = 0.002)。治疗第 2 周,高剂量组 22.6%的患者达到早期反应,而低剂量组为 12.4%,差异有统计学意义( = .026)。(2)第 1 周早期发作的相关因素包括基线 HAMA 总分(OR=0.916,95%CI 0.882-0.952)、年龄(OR=0.974,95%CI 0.950-0.998)、药物剂量(30mg 比 60mg;OR=0.298,95%CI 0.156-0.568)和 SF-12 生理总分(OR=1.030,95%CI 1.010-1.050)。(3)早期发作与反应率(OR=18.34,95%CI 12.10-27.81)、显著反应率(OR=27.56,95%CI 11.65-65.17)和恢复率(OR=11.85,95%CI 4.98-28.18)显著相关。组间(高剂量组比低剂量组)( = 8.535, = .003)和基线 HAMA 总分( = 70.840, < .001)是发作时间的独立预测因素。

结论

高剂量坦度螺酮治疗 GAD 的早期结局优于低剂量组。发病年龄较小、焦虑症状较轻、生理功能较好的患者给予高剂量坦度螺酮,起效迅速,早期疗效好,恢复率高,预后良好。药物起效时间对治疗结局有较好的预测作用。

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