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

Relapse prevention in panic disorder with pharmacotherapy: where are we now? Introduction: A substantial number of patients with PD experience relapse after the discontinuation of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk. Area covered: The present systematic review examines randomized, double-blind, placebo-controlled relapse prevention studies published over the last 20 years involving recommended medications. The authors aim to provide an overview of this topic and evaluate whether recent advances were achieved. Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy with constant doses had protective effects against relapse in patients who had previously exhibited satisfactory responses to the same medication at the same doses. The duration of maintenance treatment did not influence relapse risk. No data were available concerning the use of lower doses or the predictors of relapse. Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive indications are lacking. Rethinking pharmacological research in PD may be productive. Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter longterm naturalistic studies, and implementing recent technological innovations (e.g., electronic medical records/‘big data’ platforms, wearable devices, and machine learning techniques) may help identify reliable predictive models.惊恐障碍（Panic Disorder, PD）药物治疗的复发预防：当前研究进展如何？ 引言：相当数量的惊恐障碍患者在停用有效药物治疗后会出现病情复发，这不仅对患者个体造成不良影响，还产生了可观的社会成本。这一现状提示亟需优化药物治疗方案，以最大限度降低复发风险。 研究范围：本系统综述（systematic review）梳理了近20年间发表的、针对临床推荐用药的随机双盲安慰剂对照复发预防研究。本文旨在全面概述该主题，并评估近年来是否取得了相关研究进展。本次纳入的研究仅7项，所得结果较为有限。研究显示，对于既往以相同剂量、相同药物获得满意疗效的患者，采用恒定剂量的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显著影响。目前尚无关于低剂量用药方案或复发预测因素的相关研究数据。 专家意见：惊恐障碍的复发预防研究尚未受到足够关注，目前仍缺乏明确的研究进展与确凿的指导性证据。重新审视惊恐障碍的药理学研究或可带来新的研究突破。未来可通过开展大规模多中心长期自然观察研究，收集多维度的临床特征、个体特质与生物标志物（biomarkers），并结合电子病历（electronic medical records）/“大数据”平台、可穿戴设备（wearable devices）以及机器学习（machine learning）等新兴技术手段，助力构建可靠的复发预测模型。