Evidence from Cochrane systematic reviews on pharmacological treatment compared to placebo for panic disorder

Rosa, Manuelle Mastrorocco Brand; Fragoso, Yara Dadalti; Scaciota, Ana Carolina Lemes; Crizol, Giuliana Raduan; Colovati, Mileny Esbravatti Stephano; Moura, Eduardo Calmon de; Martimbianco, Ana Luiza Cabrera

doi:10.1590/1980-5764-dn-2022-0022

Acessibilidade / Reportar erro

Brasil

Dementia & Neuropsychologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Views & Reviews • Dement. neuropsychol. 16 (4) • Oct-Dec 2022 • https://doi.org/10.1590/1980-5764-dn-2022-0022 copy

Evidence from Cochrane systematic reviews on pharmacological treatment compared to placebo for panic disorder

EVIDÊNCIAS DAS REVISÕES SISTEMÁTICAS COCHRANE SOBRE O TRATAMENTO FARMACOLÓGICO COMPARADO AO PLACEBO PARA TRANSTORNO DE PÂNICO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Panic disorder is an anxiety condition characterized by recurrent and unexpected panic attacks. The comparison between active treatment and placebo is essential to analyze an intervention’s efficacy and safety. It is important to identify and summarize the studies with higher evidence to assist health professionals and public policy managers in clinical decision-making.

Objective:

The aim of this study was to identify and summarize all Cochrane systematic reviews (SRs) that compared the efficacy and safety of any drug treatment compared to placebo for panic disorder patients.

Methods:

SRs published in the Cochrane Library were included without date restriction. All outcomes presented were analyzed. The methodological quality of the SRs was evaluated using the AMSTAR-2 tool.

Results:

We included three Cochrane SRs of high methodological quality on the effects of antidepressants, benzodiazepines, and azapirones for panic disorder. All medications showed benefits in response to treatment, symptom improvement, and reduced panic attacks. Dropouts were lower with tricyclic antidepressants and benzodiazepines and higher with azapirones. The occurrence of adverse events was higher for drug groups.

Conclusions:

Very low to moderate certainty evidence (GRADE) showed that antidepressants and benzodiazepines seem to improve clinical symptoms in individuals with short-term panic disorder compared to placebo. In addition, the use of azapirones seems to have greater adherence by patients than placebo. However, there is insufficient evidence to support its clinical efficacy.

Keywords:
Panic Disorder; Drug Therapy; Systematic Review; Evidence-Based Medicine

Systematic review, year	Number of included RCTs	Participants	Intervention	Outcomes	Time points	Certainty of the evidence (GRADE)
Bighelli et al. (2018)²¹21. Bighelli I, Castellazzi M, Cipriani A, Girlanda F, Guaiana G, Koesters M, et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2018;4(4):CD010676. https://doi: 10.1002/14651858.CD010676.pub2 https://doi.org/https://doi: 10.1002/146...	41	n=8,525 30.6-61.2 years old	Antidepressants	Treatment response Dropouts Losses due to adverse events Disease remission Panic symptoms Frequency of panic attacks Quality of life	2-6 months	Very low to moderate
Breilmann et al. (2019)²²22. Breilmann J, Girlanda F, Guaiana G, Barbui C, Cipriani A, Castellazzi M, et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2019;3(3):CD010677. https://doi.org/10.1002/14651858.CD010677.pub2 https://doi.org/https://doi.org/10.1002/...	24	n=4,233 18 and 73 years old	Benzodiazepines	Treatment response Dropouts Losses due to adverse events Disease remission Social interaction Panic symptoms Frequency of panic attacks Agoraphobia, anxiety, and depression	1-6 months	Very low to low
Imai et al. (2014)²³23. Imai H, Tajika A, Chen P, Pompoli A, Guaiana G, Castellazzi M, et al. Azapirones versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2014;(9):CD010828. https://doi.org/10.1002/14651858.CD010828.pub2 https://doi.org/https://doi.org/10.1002/...	3	n=170 Over 18 years old	Azapirones	Treatment response Dropouts Losses due to adverse events	2 months	Low to moderate

AMSTAR-2 tool domains	Systematic reviews
AMSTAR-2 tool domains	Bighelli et al. (2018)²¹21. Bighelli I, Castellazzi M, Cipriani A, Girlanda F, Guaiana G, Koesters M, et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2018;4(4):CD010676. https://doi: 10.1002/14651858.CD010676.pub2 https://doi.org/https://doi: 10.1002/146...	Breilmann et al. (2019)²²22. Breilmann J, Girlanda F, Guaiana G, Barbui C, Cipriani A, Castellazzi M, et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2019;3(3):CD010677. https://doi.org/10.1002/14651858.CD010677.pub2 https://doi.org/https://doi.org/10.1002/...	Imai et al. (2014)²³23. Imai H, Tajika A, Chen P, Pompoli A, Guaiana G, Castellazzi M, et al. Azapirones versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2014;(9):CD010828. https://doi.org/10.1002/14651858.CD010828.pub2 https://doi.org/https://doi.org/10.1002/...
1. Search question (PICO)	Yes	Yes	Yes
2. Study planning (protocol)	Yes	Yes	Yes
3. Justification for the selection of the study design	Yes	Yes	Yes
4. Search strategies	Yes	Yes	Yes
5. Selection of peer studies	Yes	Yes	Yes
6. Data extraction in pairs	Yes	Yes	Yes
7. Report of excluded studies	Yes	Yes	Yes
8. Characteristics of the studies included	Yes	Yes	Yes
9. Risk assessment of bias	Yes	Yes	Yes
10. Reporting of the sources of funding for the studies	Yes	Yes	Yes
11. Appropriate statistical methods	Yes	Yes	Yes
12. Assessment of the impact of the risk of bias in meta-analyses	Yes	Yes	Yes
13. Risk of bias in interpretation and results	Yes	Yes	Yes
14. Discussion and explanation of heterogeneity	Yes	Yes	Yes
15. Investigation of publication bias	Yes	Yes	Yes
16. Report of conflict of interest of the authors of the review	Yes	Yes	Yes
Total (quality)	High quality	High quality	High quality

	Main results (95%CI)
	Treatment response rate	Number of dropouts (for any reason)	Losses from adverse events
Antidepressants versus placebo
Any class	RR 0.72 [0.66-0.79]* 30 RCT, n=6,500 Low-certainty evidence	RR 0.88 [0.81-0.97]* 38 RCT, n=7,850 Low-certainty evidence	RR 1.49 [1.25-1.78]* 33 RCT, n=7,688 Low-certainty evidence
Tricyclic antidepressants	RR 0.73 [0.63-0.86]* 9 RCT, n=829	RR 0.74 [0.63-0.86]* 17 RCT, n=1,906	RR 1.97 [1.33-2.91]* 10 RCT, n=1,641
Selective Serotonin Reuptake Inhibitors (SSRIs)	RR 0.75 [0.67-0.84]* 21 RCT, n=4,000	No difference with placebo	RR 1.45 [1.16-1.81]* 22 CT, n=4,131
Monoamine oxidase inhibitors (MAOIs)	RR 0.55 [0.34-0.88]* 1 RCT, n=29	NA	NA
Selective serotonin-norepinephrine reuptake inhibitors (ISRSN)	RR 0.61 [0.41-0.91]* 4 RCT, n=1,531	No difference with placebo	No difference with placebo
Noradrenergic resorption inhibitors	RR 0.71 [0.51-0.97]* 1 RCT, n=82	RR 0.50 [0.28-0.90]* 1 RCT, n=82	No difference with placebo
Benzodiazepines versus placebo	RR 1.65 [1.39-1.96]* 16 RCT, n=2,476 Low-certainty evidence	RR 0.50 [0.39-0.64]* 21 RCT, n=3,558 Low-certainty evidence	RR 1.58 [1.16-2.15]* 5 RCT, n=3,263 Low-certainty evidence
Azapirones versus placebo	NA	RR 2.13 [1.11-4.07]* 3 RCT, n=170 Moderate-certainty evidence	NA

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Mileny Esbravatti Stephano Colovati; Email: mcolovati@yahoo.com.br.