Efficacy and Tolerability of Pharmacotherapy for Pediatric Anxiety Disorders
| Autor: | Jeffrey R. Strawn, Michael H. Bloch, Eric T. Dobson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Network Meta-Analysis Placebo 03 medical and health sciences 0302 clinical medicine Pharmacotherapy Internal medicine Humans Medicine Neurotransmitter Uptake Inhibitors 0501 psychology and cognitive sciences Child business.industry 05 social sciences Odds ratio Anxiety Disorders Discontinuation Psychiatry and Mental health Treatment Outcome Tolerability Strictly standardized mean difference Meta-analysis Anxiety medicine.symptom business 030217 neurology & neurosurgery 050104 developmental & child psychology |
| Zdroj: | The Journal of Clinical Psychiatry. 80 |
| ISSN: | 1555-2101 |
| Popis: | Objective To evaluate the efficacy and tolerability of pharmacotherapy in pediatric anxiety disorders using network meta-analysis. Data sources PubMed, Cochrane Database, Web of Science, PsycNET, and ClinicalTrials.gov were searched for double-blind, controlled pharmacotherapy trials in youth with anxiety disorders from 1966 to September 2017. Data selection All double-blind, placebo-controlled trials of pharmacotherapy in the treatment of pediatric patients with generalized, social, and/or separation anxiety disorders were included. Data extraction We extracted demographic, symptom severity, global improvement, discontinuation, and suicidality data. Risk of bias was assessed with the Cochrane risk-of-bias tool, and a network meta-analysis comparing the efficacy and tolerability of medications and medication classes was performed using the gemtc package (R). Results We identified 20 citations (22 RCTs, 24 treatment arms) with 2,623 patients. Selective serotonin reuptake inhibitors (SSRIs) were the only class that was superior in reducing anxiety (standardized mean difference: 5.2; credible interval [CrI]: [2.8 to 8.8]) and in likelihood of treatment response compared to placebo (odds ratio [OR]: 4.6; CrI: [3.1 to 7.5]). Serotonin-norepinephrine reuptake inhibitor (SNRI) and α₂ agonist treatment were associated with more frequent treatment response compared to placebo. The likelihood of treatment response was greater for SSRIs compared to SNRIs (OR: 1.9; CrI: [1.1 to 3.5]). All-cause discontinuation and treatment-emergent suicidality significantly differed among medications but not medication class. Conclusions Although multiple medications reduce anxiety in children and adolescents, treatment response, tolerability, and treatment-emergent suicidality differ among these medications and medication classes. Determining whether efficacy and tolerability differences represent true differences (or reflect differences in trial design) requires additional head-to-head medication trials and-to exclude the impact of missing treatment interventions-requires trials of medications that successfully treat anxiety in adults but that have not been evaluated in youth. |
| Databáze: | OpenAIRE |
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