Intervention Review

Azapirones for generalized anxiety disorder

  1. Cheryl A Chessick1,*,
  2. Michael H Allen2,
  3. Michael E. Thase3,
  4. Angelo ABC Batista Miralha da Cunha4,
  5. Flavio FK Kapczinski5,
  6. Mauricio Silva de Lima6,
  7. Juliano JSS dos Santos Souza4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 22 MAY 2006

DOI: 10.1002/14651858.CD006115


How to Cite

Chessick CA, Allen MH, Thase ME, Batista Miralha da Cunha AABC, Kapczinski FFK, Silva de Lima M, dos Santos Souza JJSS. Azapirones for generalized anxiety disorder. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD006115. DOI: 10.1002/14651858.CD006115.

Author Information

  1. 1

    University of Colorado Health Sciences Center, Psychiatry, Devner, Colorado, USA

  2. 2

    University of Colorado School of Medicine, Denver, Colorado, USA

  3. 3

    University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, USA

  4. 4

    Federal University of Santa Maria - UFSM, Department of Neuropsychiatry, Porto Alegre, RS, Brazil

  5. 5

    Federal University of Rio Grande do Sul - UFRGS, Department of Psychiatry, Porto Alegre, RS, Brazil

  6. 6

    Eli Lilly & Co, Medical, Basingstoke, Hampshire, UK

*Cheryl A Chessick, Psychiatry, University of Colorado Health Sciences Center, 4455 E. 12th Avenue, A011-21, Devner, Colorado, 80220, USA. cheryl.chessick@uchsc.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

SEARCH

 

Abstract

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

Background

Azapirones are a group of drugs that work at the 5-HT1A receptor and are used to treat patients suffering from generalized anxiety disorder (GAD). However, several studies have shown conflicting results. Whether azapirones are useful as first line treatment in general anxiety disorders still needs to be answered.

Objectives

To assess the efficacy and the acceptability of azapirones for the treatment of GAD.

Search methods

Initiallyt the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched, incorporating results of group searches of MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), CINAHL (1982 to June 2005), PsycLIT (1974 to June 2005), PSYNDEX (1977 to June 2005), and LILACS (1982 to June 2005). Subsequently the revised Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) were searched on 21-10-2005. Reference lists of relevant papers and major text books of anxiety disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable trials, published or unpublished. Specialist journals concerning azapirones were handsearched.

Selection criteria

Randomized controlled trials of azapirones, including buspirone versus placebo and/or other medication and/or psychological treatment, were included. Participants were males and females of all ages with a diagnosis of generalized anxiety disorder.

Data collection and analysis

Data were extracted from the original reports independently by CC, MA and MT. The main outcomes studied were related to the objectives stated above. Data were analysed for generalized anxiety disorder versus placebo, versus other medication and versus psychological treatment separately. Data were analysed using Review Manager Version 4.2.7.

Main results

Thirty six trials were included in the review, reporting on 5908 participants randomly allocated to azapirones and/or placebo, benzodiazepines, antidepressants, psychotherapy or kava kava. Azapirones, including buspirone, were superior to placebo in treating GAD. The calculated number needed to treat for azapirones using the Clinical Global Impression scale was 4.4 (95% confidence interval (CI) 2.16 to 15.4). Azapirones may be less effective than benzodiazepines and we were unable to conclude if azapirones were superior to antidepressants, kava kava or psychotherapy. Azapirones appeared to be well tolerated. Fewer participants stopped taking benzodiazepines compared to azapirones. The length of studies ranged from four to nine weeks, with one study lasting 14 weeks.

Authors' conclusions

Azapirones appeared to be useful in the treatment of GAD, particularly for those participants who had not been on a benzodiazepine. Azapirones may not be superior to benzodiazepines and do not appear as acceptable as benzodiazepines. Side effects appeared mild and non serious in the azapirone treated group. Longer term studies are needed to show that azapirones are effective in treating GAD, which is a chronic long-term illness.

 

Plain language summary

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

Azapirones for generalized anxiety disorder (GAD)

Generalized anxiety disorder is one of the most common anxiety disorders and can be costly if unrecognized or left untreated. Azapirones are a group of drugs that work at the 5-HT1A receptor and are used to treat patients suffering from GAD. This systematic review evaluates the effectiveness of azapirones compared to other treatments. From the results of 36 randomized controlled trials, azapirones appear to be superior to placebo in short-term studies (four to nine weeks) but may not be superior to benzodiazepines. We were unable to conclude if azapirones were superior to antidepressants, psychotherapy or kava kava. As GAD is generally chronic in nature, conclusions about azapirones' long-term efficacy are not able to be made and longer term trials are needed.

 

摘要

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

背景

Azapirones類藥物使用於廣泛性焦慮症

Azapirones類藥物是指一群作用在5HT1A受器的藥物,用來治療廣泛性焦慮症(GAD),然而很多試驗顯示衝突的結論,是否azapirones類藥物為有效的第一線治療在廣泛性焦慮症仍然需要得到回答。

目標

評估azapirones類藥物在治療廣泛性焦慮症(GAD)的效果及接受度。

搜尋策略

一開始搜尋Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register(CCDANCTR)及Cochrane Central Register of Controlled Trials(CENTRAL),且納入MEDLINE(1966年到2005年6月),EMBASE(1980年到2005年6月), CINAHL(1982年到2005年6月),PsycLIT(1974年到2005年6月),PSYNDEX(1977年到2005年6月)及LILACS(1982年到2005年6月)群組搜尋結果。在2005年10月21日搜尋隨後修訂的Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers(CCDANCTR研究及CCDANCTR文獻)。我們檢視相關文章的參考文獻以及關於焦慮症的一些主要的教科書,也接觸了相關試驗(發表的或是還沒發表的)的作者、專家以及藥廠來獲得進一步的訊息,另外也搜尋了有關azapirones類藥物的專業期刊。

選擇標準

我們納入azapirones類藥物的隨機對照試驗,包括比較buspirone和安慰劑及(或)其他藥物及(或)心理治療。受試者包含各年齡層診斷為廣泛性焦慮症的男性及女性。

資料收集與分析

內容資料由作者CC、MA及MT分別獨立地擷取自原始文獻。選取的主要預後評估跟上述的目標相關,同時分別針對與安慰劑、其他藥物及心理治療的比較來分析,使用的是Review Manager Version 4.2.7.軟體。

主要結論

本篇回顧文章共納入36個試驗,一共含有5908位受試者被隨機分配到azapirones類藥物組及/或安慰劑組、benzodiazepines類藥物組、抗憂鬱劑組、心理治療組或卡瓦根(kava kava)組。結果顯示,Azapirones類藥物,包括buspirone,在治療廣泛性焦慮症優於安慰劑,使用臨床綜合印象評估(Clinical Global Impression Scale)來計算azapirone的需要治療的病人數(number needed to treat)是4.4(95%信賴區間(CI)是2.16到15.4)。Azapirones可能比benzodiazepine類藥物效果不好,另外對於azapirones類藥物是否優於抗憂鬱劑、卡瓦根(kava kava或心理治療,目前還無法下定論。Azapirones類藥物有不錯的耐受性,不過使用benzodiazepines類藥物的卻較少受試者停藥。這些試驗持續的期間從4週到9週不等,而有一個試驗則持續了14週。

作者結論

Azapirones類藥物在治療廣泛性焦慮症似乎是有效的,特別是那些未使用benzodiazepines類藥物的受試者。Azapirones類藥物可能沒有比benzodiazepines類藥物要來得有效,同時接受度也比較不那麼高。使用azapirones類藥物出現的副作用輕微且不嚴重。對於廣泛性焦慮症這種慢性疾病而言,要證實Azapirones類藥物的確切療效是需要更長期的研究報告。

翻譯人

本摘要由彰化基督教醫院許文郁翻譯。

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

總結

我們回顧了使用azapirones類藥物在治療廣泛性焦慮症(GAD)的臨床試驗。廣泛性焦慮症是最常見的焦慮性疾患當中的一種,假如沒有辨識出來或沒有接受治療,那麼代價會是很大的。Azapirones類藥物指的是一群作用在5HT1A受器的藥物,通常被用來治療廣泛性焦慮症(GAD)。這篇系統性回顧文章是要去評估azapirones類藥物相較於其他治療方式的效果。從這36個隨機對照試驗的結果看起來,短期的試驗(4週到9週)顯示azapirones類藥物優於安慰劑,但可能沒有優於benzodiazepines類藥物。我們對於azapirones類藥物是否優於抗憂鬱劑、卡瓦根(kava kava)或心理治療還無法作出結論。對於廣泛性焦慮症這種偏慢性化的疾病而言,azapirones類藥物是否具有長期性的效果還不得而知,這部分得需要更長期的試驗來加以證實。