Intervention Review

Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders

  1. Jonathan C Ipser1,*,
  2. Paul Carey2,
  3. Yumna Dhansay1,
  4. Nuraan Fakier2,
  5. Soraya Seedat1,
  6. Dan J Stein3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 21 AUG 2006

DOI: 10.1002/14651858.CD005473.pub2

How to Cite

Ipser JC, Carey P, Dhansay Y, Fakier N, Seedat S, Stein DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005473. DOI: 10.1002/14651858.CD005473.pub2.

Author Information

  1. 1

    University of Stellenbosch, MRC Research Unit for Anxiety and Stress Disorders, Tygerberg, Western Cape, South Africa

  2. 2

    University of Stellenbosch, Psychiatry, Tygerberg, Western Cape, South Africa

  3. 3

    University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa

*Jonathan C Ipser, MRC Research Unit for Anxiety and Stress Disorders, University of Stellenbosch, PO Box 19063, Tygerberg, Western Cape, 7505, South Africa. jonathan.ipser@uct.ac.za.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A large proportion of patients with anxiety disorders fail to respond to first-line medication interventions, despite evidence of the effectiveness of these agents.

Objectives

To assess the effects of medication versus placebo augmentation in the treatment of patients with anxiety disorders who have failed to respond adequately to first-line drug therapies.

Search methods

The Cochrane Depression, Anxiety & Neurosis Group (CCDAN) specialised registers (CCDANCTR-Studies and CCDANCTR-References) were searched on 3/8/2005, , MEDLINE (January 1966 to July 2005) and PsycINFO (1966 to 2005, Part A). Unpublished trials were identified through the Controlled Trials database and the National Institute of Health's Computer Retrieval of Information on Scientific Projects (CRISP) service (1972 to 2005). Additional studies in any language were sought in reference lists of retrieved articles.

Selection criteria

All randomised controlled trials (RCTs) of the medication augmentation of pharmacotherapy for treatment resistant anxiety disorders.

Data collection and analysis

Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by class of augmentation agent and anxiety disorder. Overall effect estimates were calculated using a random-effects model, heterogeneity was assessed and subgroup/sensitivity analyses were undertaken.

Main results

Twenty eight short-term (average of seven weeks) randomised controlled trials (740 participants) were included in the review, 20 of which investigated augmentation of medication for treatment-resistant obsessive compulsive disorder (OCD). Summary statistics for responder status from nine trials demonstrate overall superiority of a variety of medication agents to placebo (relative risk of non-response (RR) 3.16, 95% CI 1.08 to 9.23). Similarly, symptom severity was significantly reduced in the medication groups, relative to placebo (number of trials (N) = 14, standardised mean difference (SMD) -0.87, 95% CI -1.37 to -0.36). There is no evidence of a difference between medication and placebo in total dropout rate, or in the number of dropouts due to adverse events.

Authors' conclusions

Medication augmentation can be an effective and well-tolerated short-term treatment strategy for non-responders to first-line pharmacotherapy of anxiety disorders. However, any conclusions must be tentative in view of methodological and clinical heterogeneity, and the fact that much of the relevant database is based on antipsychotic augmentation trials in OCD patients resistant to serotonin reuptake inhibitors (SRIs). Additional data are needed to address several areas, including the efficacy of augmentation over the longer-term, and the value of medication augmentation in comparison to other strategies (eg switching medication, adding psychotherapy).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Medication augmentation for treatment-resistant anxiety disorders

Anxiety disorders are highly prevalent and result in substantial socio-economic and personal costs. A significant proportion of patients with anxiety disorders fail to respond to first-line medication interventions. This was a systematic review of 28 short-term randomised controlled trials of medication augmentation for the treatment of such individuals (740 participants). A significantly larger proportion of patients responded to medication (31.8%) than to placebo (13.6%), (nine trials, 250 participants). Symptom severity was also significantly reduced (14 trials, 337 participants). A substantial proportion of the efficacy evidence base was for the augmentation with antipsychotics of serotonin reuptake inhibitors for obsessive compulsive disorder.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

難治型焦慮症的加藥策略

即便藥物證實有效,許多焦慮症患者仍對這些第一線的藥物治療沒有反應,

目標

對第一線藥物治療反應不好的焦慮症患者,使用添加藥物或安慰劑,並比較兩組療效。

搜尋策略

在3/8/2005當日搜尋The Cochrane Depression, Anxiety & Neurosis Group (CCDAN) specialised registers (CCDANCTRStudies and CCDANCTRReferences) 及PsycINFO (1966 to 2005, Part A). 由Controlled Trials資料庫和 National Institute of Health's Computer Retrieval of Information on Scientific Projects (CRISP) service (1972 to 2005)上搜尋未發表試驗.由搜尋到的文章文獻清單中尋找是否有其他語言的研究。

選擇標準

所有隨機對照試驗,比較難治型焦慮症的加藥策略

資料收集與分析

兩位檢閱者獨立評核隨機控制試驗判斷是否應該納入、並整理試驗數據及評估試驗品質。連絡試驗負責人以取得欠缺的數據。總統計量以焦慮疾病與藥物增強的類別分層。整體效果評估以隨機效果模式來計算,異質性有經過評估,也有做次分類(subgroup)及敏感度分析。

主要結論

28個短期(平均七週)隨機控制試驗(740個受試者)被納入這篇回顧,其中的20個試驗在研究頑抗型強迫症的藥物增強治療。九篇統計結果顯示:許多的藥物組有反應的受試者比率明顯優於安慰劑組(無反應的RR 3.16, 95% CI 1.08 – 9.23)。同樣地,藥物組的症狀嚴重度明顯比安慰劑組輕(共14個試驗, 標準平均差 −0.87, 95% CI −1.37, −0.36)。沒有證據顯示藥物組及安慰劑組在整體退出率,或者在因副作用退出的個案數上有差異。

作者結論

對第一線藥物治療無反應的焦慮症患者,藥物增強治療可以是有效且可耐受的短期治療策略。但是做出任何結論前,應考慮方法學,臨床異質性和回顧的資料庫多為對SRIs有耐受性的強迫症患者,進行的抗精神藥物加藥試驗.需要其他研究以下領域的試驗:長期加藥的療效,加藥與其他策略(換藥,增加其它精神病療法)相比的療效.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

這是一個系統性統合分析回顧,研究難治型焦慮症患者的加藥策略。焦慮症盛行率高,造成顯著社會經濟和個人損失.很多焦慮症患者對第一線藥物沒有反應,此系統性回顧整理28個短期隨機對照試驗,對這些患者加藥的療效(共740位受試者).9個試驗250位受試者中,對治療產生反應的比率分別為:藥物組(31.8%)與安慰劑(13.6%),藥物組顯著較高的.藥物組的症狀也顯著減輕(14個試驗共337位受試者).大部分的研究是對SRIs有耐受性的強迫症患者加抗精神病藥物.