Gabriela de Moraes Costa1, Fabricio Batistin Zanatta2, Patricia Klarmann Ziegelmann3, Alcina Juliana Soares Barros4, Carlos Fernando Mello5. 1. Department of Neuropsychiatry, Center of Health Sciences, Assistant Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 26, room 1445, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil. Electronic address: gabriela.m.costa@ufsm.br. 2. Department of Stomatology, Postgraduate Program in Dentistry, Adjunct Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 26 F, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil. Electronic address: fabriciobzanatta@gmail.com. 3. Statistics Department, Postgraduate Program in Epidemiology, Full Professor, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos Street, no 2400, Zip code 90035003, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: patricia.ziegelmann@ufrgs.br. 4. Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos Street, nº 2400, Zip code 90035003, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: alcina.forense@gmail.com. 5. Department of Physiology and Pharmacology, Center of Health Sciences, Postgraduate Program in Pharmacology, Full Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 21, room 5118, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil. Electronic address: cf.mello@smail.ufsm.br.
Abstract
BACKGROUND: The purpose of this study was to compare efficacy and acceptability among drug treatments for adults with post-traumatic stress disorder (PTSD) through a systematic review, random-effects pairwise and network meta-analyses. METHODS: Double-blind randomized controlled trials comparing pharmacological interventions for adults with PTSD were searched from database inception through Aug. 28, 2018, on Cochrane (Central), Embase, LILACS, PILOTS, PsycINFO, PubMed, and Web of Science. Clinical trial registries and the websites of pharmaceutical companies were also searched. The GRADE system was used to assess the quality of the evidence. RESULTS: The systematic review included 58 studies comprising 6766 patients randomized to 26 different interventions. Regarding efficacy, topiramate (SMD = -0.57; 95%CrI: -1.07,-0.10), risperidone (SMD = -0.53; 95%CrI: -0.93,-0.15), quetiapine (SMD = -0.59; 95%CrI: -1.06,-0.11), paroxetine (SMD = -0.35; 95%CrI: -0.48,-0.21), venlafaxine (SMD = -0.25; 95%CrI: -0.44,-0.05), fluoxetine (SMD = -0.28; 95%CrI: -0.46,-0.08), and sertraline (SMD = -0.21; 95%CrI: -0.33,-0.09) outperformed placebo. Moreover, phenelzine (RR = 3.39; 95%CrI: 1.43,11.09), lamotrigine (RR = 4.39; 95%CrI: 1.18,26.38), and fluoxetine (RR = 1.28%CrI: 1.01,1.59) outperformed placebo in terms of acceptability. CONCLUSIONS: The NMA supports topiramate, risperidone, quetiapine, paroxetine, venlafaxine, fluoxetine and sertraline as effective pharmacological choices for the treatment of PTSD. Quetiapine and topiramate have the shortcoming of relying on a few small studies, but the clinically meaningful change in symptoms is noteworthy and merits further investigation. Among the pharmacological treatments with evidence of efficacy compared to placebo, fluoxetine achieved a relatively high rank regarding acceptability. To the best of our knowledge, this is the largest contemporary NMA on the subject and the addition of new medications is an important extension of previous meta-analyses, enabling a larger number of drug comparisons.
BACKGROUND: The purpose of this study was to compare efficacy and acceptability among drug treatments for adults with post-traumatic stress disorder (PTSD) through a systematic review, random-effects pairwise and network meta-analyses. METHODS: Double-blind randomized controlled trials comparing pharmacological interventions for adults with PTSD were searched from database inception through Aug. 28, 2018, on Cochrane (Central), Embase, LILACS, PILOTS, PsycINFO, PubMed, and Web of Science. Clinical trial registries and the websites of pharmaceutical companies were also searched. The GRADE system was used to assess the quality of the evidence. RESULTS: The systematic review included 58 studies comprising 6766 patients randomized to 26 different interventions. Regarding efficacy, topiramate (SMD = -0.57; 95%CrI: -1.07,-0.10), risperidone (SMD = -0.53; 95%CrI: -0.93,-0.15), quetiapine (SMD = -0.59; 95%CrI: -1.06,-0.11), paroxetine (SMD = -0.35; 95%CrI: -0.48,-0.21), venlafaxine (SMD = -0.25; 95%CrI: -0.44,-0.05), fluoxetine (SMD = -0.28; 95%CrI: -0.46,-0.08), and sertraline (SMD = -0.21; 95%CrI: -0.33,-0.09) outperformed placebo. Moreover, phenelzine (RR = 3.39; 95%CrI: 1.43,11.09), lamotrigine (RR = 4.39; 95%CrI: 1.18,26.38), and fluoxetine (RR = 1.28%CrI: 1.01,1.59) outperformed placebo in terms of acceptability. CONCLUSIONS: The NMA supports topiramate, risperidone, quetiapine, paroxetine, venlafaxine, fluoxetine and sertraline as effective pharmacological choices for the treatment of PTSD. Quetiapine and topiramate have the shortcoming of relying on a few small studies, but the clinically meaningful change in symptoms is noteworthy and merits further investigation. Among the pharmacological treatments with evidence of efficacy compared to placebo, fluoxetine achieved a relatively high rank regarding acceptability. To the best of our knowledge, this is the largest contemporary NMA on the subject and the addition of new medications is an important extension of previous meta-analyses, enabling a larger number of drug comparisons.
Authors: Chelsea Jones; Lorraine Smith-MacDonald; Matthew Robert Graham Brown; Ashley Pike; Eric Vermetten; Suzette Brémault-Phillips Journal: Brain Behav Date: 2022-07-18 Impact factor: 3.405
Authors: Noah R Delapaz; William K Hor; Michael Gilbert; Andrew D La; Feiran Liang; Peihao Fan; Xiguang Qi; Xiaojiang Guo; Jian Ying; Dara Sakolsky; Levent Kirisci; Jonathan C Silverstein; Lirong Wang Journal: J Pers Med Date: 2021-03-04