Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis Full Text
British Medical Journal, 04/08/2011
Evidence Based Medicine
Baldwin D et al. - Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes, the probabilistic analysis, which did not rely on significant outcomes, showed that fluoxetine and sertraline seem to have some advantages over other treatments. Among five UK licensed treatments, duloxetine, escitalopram, and pregabalin might offer some advantages over venlafaxine and paroxetine.Methods
- Double blind placebo controlled randomised controlled trials; published systematic reviews and meta-analyses of randomised controlled trials.
- Randomised controlled trials including adult participants (aged >18) receiving any pharmacological treatment for generalised anxiety disorder.
- Titles or abstracts reviewed initially, followed by review of full text publications for citations remaining after first pass.
- A three person team conducted screening; an independent reviewer checked a random selection (10%) of articles screened.
- The review identified 3249 citations, and 46 randomised controlled trials met inclusion criteria; 27 trials contained sufficient or appropriate data for inclusion in the analysis.
- Analyses compared nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine).
- In the primary probabilistic mixed treatment meta-analyses, fluoxetine was ranked first for response and remission (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%).
- In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response, escitalopram was ranked first for remission, and pregabalin was ranked first for tolerability.