Generalized anxiety: meta-analysis evaluates pharmacologic options

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Takeaway

  • A number of viable medications are available for the treatment of generalized anxiety disorder (GAD), crossing drug classes and offering options after initial treatment failure, according to the largest network analysis to date.
  • Duloxetine, pregabalin, venlafaxine, and escitalopram were more effective and relatively well tolerated vs placebo.

Why this matters

  • The study features data from 89 randomized trials with more than 25,000 patients, including studies not included in prior meta-analyses that were published only in Chinese on drugs that have not been studied elsewhere.

Study design

  • Network meta-analysis of 89 trials including 25,441 patients, randomly assigned to 22 different active treatments or placebo.
  • Primary efficacy outcome: change in Hamilton Anxiety Scale Score.
  • Funding: None.

Key results

  • Follow-up duration: range, 4-26 weeks.
  • Effective and well-tolerated treatments:
    • Duloxetine (mean difference [MD], −3.13; 95% credible interval [CrI], −4.13 to −2.13), pregabalin (MD, −2.79; 95% CrI, −3.69 to −1.91), venlafaxine (MD, −2.69; 95% CrI, −3.50 to −1.89), and escitalopram (MD, −2.45; 95% CrI, −3.27 to −1.63).
    • Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine (small sample sizes).
    • Agomelatine among newer options.
  • Quetiapine, paroxetine, and benzodiazepines were effective but poorly tolerated.

Limitations

  • Nonpharmacological treatments were not evaluated.

Coauthored with Antara Ghosh, PhD