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

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.

摘要。惊恐障碍是一类以反复发作且无预期诱因的惊恐发作为特征的焦虑病症。比较阳性治疗与安慰剂的差异，是分析干预措施有效性与安全性的核心环节。筛选并总结高等级证据的相关研究，可助力医疗从业者与公共政策管理者开展临床决策。目的：本研究旨在筛选并汇总所有针对惊恐障碍患者，比较任意药物治疗与安慰剂的有效性及安全性的Cochrane系统评价（Systematic Reviews, SRs）。方法：纳入无发表时间限制的、发表于Cochrane图书馆的系统评价，对所有报告结局进行分析。采用AMSTAR-2工具对纳入系统评价的方法学质量进行评估。结果：本研究共纳入3篇方法学质量优良的Cochrane系统评价，分别针对抗抑郁药、苯二氮䓬类药物及阿扎哌隆类药物治疗惊恐障碍的疗效展开分析。所有受试药物均能改善治疗应答、缓解临床症状并减少惊恐发作频次。三环类抗抑郁药与苯二氮䓬类药物的治疗脱落率更低，而阿扎哌隆类药物的脱落率更高。药物治疗组的不良事件发生率更高。结论：基于GRADE（Grading of Recommendations Assessment, Development and Evaluation）分级的极低至中等确定性证据显示：相较于安慰剂，抗抑郁药与苯二氮䓬类药物可改善短期病程惊恐障碍患者的临床症状。此外，相较于安慰剂，阿扎哌隆类药物的患者治疗依从性更佳，但现有证据不足以支持其临床有效性。