焦虑症患者发育对抗抑郁药和安慰剂反应的影响:对儿童、青少年和成人随机对照试验的贝叶斯层次元分析研究》(A Bayesian Hierarchical Meta-Analytic Examination of Randomized Controlled Trials in Children, Adolescents, and Adults.

IF 1.5 4区 医学 Q2 PEDIATRICS Journal of child and adolescent psychopharmacology Pub Date : 2024-09-01 Epub Date: 2024-05-27 DOI:10.1089/cap.2024.0016
Jeffrey A Mills, Eric Mendez, Jeffrey R Strawn
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引用次数: 0

摘要

背景:了解发育如何影响焦虑症患者对药物和安慰剂的反应,可为治疗决策提供依据,包括针对特定年龄段的一线与二线精神药物干预措施。目的通过荟萃分析比较选择性血清素再摄取抑制剂(SSRIs)、血清素-去甲肾上腺素再摄取抑制剂(SNRIs)和安慰剂对患有焦虑症的青少年和成人的反应轨迹。研究方法从针对患有焦虑症(广泛性焦虑症、分离焦虑症、社交焦虑症以及惊恐障碍)的儿童、青少年和成人的 SSRIs 和 SNRIs 前瞻性、随机、平行组、安慰剂对照试验中提取每周症状严重程度数据。采用贝叶斯分层模型对连续焦虑测量的标准化变化建立治疗反应模型。症状严重程度的变化作为时间的函数进行评估,并进行事后分析,以确定这些结果在样本异质性和其他函数形式之间的敏感性。研究结果数据来自11项青少年试验(SSRI,κ = 7;SNRI,κ = 4)和71项成人研究(SSRI,κ = 46;SNRI,κ = 25)。共有 1067 名青少年参与了 SSRI 试验,1024 名青少年参与了 SNRI 试验。共有10826名成人参加了SSRI试验(安慰剂,n = 5367;SSRI n = 5459),6232名成人参加了SNRI试验(安慰剂,n = 3128;SNRI n = 3094)。对数模型最能说明反应情况。青少年和成人的安慰剂反应相似(平均差异 = -1.98 ± 6.21,95% 可信区间 [CrI]:-10.2 至 14.2,P = 0.第 2 周时,成人(平均差异:-18.34 + 1.017,95% 可信区间 [CrI]:-20.3 至 16.3,p <0.001)和青少年(平均差异:-23.74 + 3.736,95% 可信区间 [CrI]:-31.1 至 -16.4,p <0.001)与基线相比均出现了统计学意义上的显著改善。SSRIs对青少年和成人的改善效果相似(p = 0.129),但SNRIs对青少年的改善效果慢于成人(p = 0.018)。结论:患有焦虑症的青少年和成年人很早就会出现抗抑郁相关的改善。SSRI 在成人和青少年中的反应相似;然而,SNRIs 在成人中产生的反应大于青少年,这可能是一种发育效应。
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The Impact of Development on Antidepressant and Placebo Response in Anxiety Disorders: A Bayesian Hierarchical Meta-Analytic Examination of Randomized Controlled Trials in Children, Adolescents, and Adults.

Background: Understanding how development influences medication and placebo responses in anxiety disorders could inform treatment decisions, including age-specific first- versus second-line psychopharmacological interventions. Objective: To meta-analytically compare the trajectory of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and placebo response in youth and adults with anxiety disorders. Methods: Weekly symptom severity data were extracted from prospective, randomized, parallel-group, placebo-controlled trials of SSRIs and SNRIs in children, adolescents, and adults with anxiety disorders (generalized, separation, and social anxiety disorders as well as panic disorder). Treatment response was modeled for the standardized change in continuous measures of anxiety using a Bayesian hierarchical model. Change in symptom severity was evaluated as a function of time, and post hoc analyses were conducted to determine the sensitivity of these results across sample heterogeneity and alternative functional forms. Results: Data were included from 11 trials of youth (SSRI, κ = 7; SNRI, κ = 4) and 71 studies of adults (SSRI, κ = 46; SNRI, κ = 25). In total, 1067 youth participated in SSRI trials and 1024 in SNRI trials. In total, 10,826 adults participated in SSRI trials (placebo, n = 5367; SSRI n = 5,459) and 6232 in SNRI trials (placebo, n = 3,128; SNRI n = 3,094). A logarithmic model best described the response. Placebo response was similar in youth and adults (mean difference = -1.98 ± 6.21, 95% credible interval [CrI]: -10.2 to 14.2, p = 0.750), and statistically significant improvement from baseline emerged by week 2 in both adults (mean difference: -18.34 + 1.017, 95% CrI: -20.3 to 16.3, p < 0.001) and youth (mean difference: -23.74 + 3.736, 95% CrI: -31.1 to -16.4, p < 0.001). SSRIs produced similar improvements for youth and adults (p = 0.129), but SNRIs produced slower improvement in youth than adults (p = 0.018). Conclusions: Antidepressant-related improvement occurs early in youth and adults with anxiety disorders. SSRI response is similar in adults and youth; however, SNRIs produce greater responses in adults than youth, potentially representing a developmental effect.

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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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