Relapse prevention in panic disorder with pharmacotherapy: where are we now?

Relapse prevention in panic disorder with pharmacotherapy: where are we now? ABSTRACT<br> Introduction: A substantial number of patients with PD experience relapse after the discontinuation<br> of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable<br> societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk.<br> Area covered: The present systematic review examines randomized, double-blind, placebo-controlled<br> relapse prevention studies published over the last 20 years involving recommended medications. The<br> authors aim to provide an overview of this topic and evaluate whether recent advances were achieved.<br> Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy<br> with constant doses had protective effects against relapse in patients who had previously exhibited<br> satisfactory responses to the same medication at the same doses. The duration of maintenance treatment<br> did not influence relapse risk. No data were available concerning the use of lower doses or the predictors<br> of relapse.<br> Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive<br> indications are lacking. Rethinking pharmacological research in PD may be productive.<br> Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter longterm<br> naturalistic studies, and implementing recent technological innovations (e.g., electronic medical<br> records/‘big data’ platforms, wearable devices, and machine learning techniques) may help identify<br> reliable predictive models.药物治疗惊恐障碍的复发预防：当前研究进展如何？ 摘要 引言：大量惊恐障碍（Panic Disorder, PD）患者在停用有效药物治疗后会出现病情复发，不仅对患者个体造成不良影响，还会产生可观的社会成本。这提示亟需优化药物治疗方案以降低复发风险。 研究范围：本系统综述梳理了近20年间发表的、针对临床推荐药物的随机双盲安慰剂对照复发预防研究。研究旨在概述该领域现状，并评估近年来是否取得了相关进展。最终仅纳入7项研究，所得结论较为有限。研究发现，对先前以相同剂量、同种药物获得满意疗效的患者而言，采用固定剂量的1年维持药物治疗可起到复发保护作用。但维持治疗的时长并未对复发风险产生影响。目前尚无关于低剂量用药或复发预测因素的相关数据。 专家观点：目前惊恐障碍的复发预防研究关注度有限，尚未取得明确进展与确凿结论。重新审视惊恐障碍的药物治疗研究或具有积极意义。通过开展大规模多中心长期自然观察研究，收集多维度临床特征、个体特征及生物标志物，并结合当前技术创新（如电子病历/「大数据」平台、可穿戴设备及机器学习技术），或可助力构建可靠的复发预测模型。