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Meta-Analysis
. 2016 Jan 12:10:259-76.
doi: 10.2147/DDDT.S89485. eCollection 2016.

Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials

Narong Maneeton  1 , Benchalak Maneeton  1 , Pakapan Woottiluk  2 , Surinporn Likhitsathian  1 , Sirijit Suttajit  1 , Vudhichai Boonyanaruthee  1 , Manit Srisurapanont  1
Affiliations
Meta-Analysis

Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials

Narong Maneeton et al. Drug Des Devel Ther. .

Abstract

Background: Some studies have indicated the efficacy of quetiapine in the treatment of generalized anxiety disorder (GAD).

Objective: The purpose of this study was to systematically review the efficacy, acceptability, and tolerability of quetiapine in adult patients with GAD.

Methods: The SCOPUS, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched in April 2015. All randomized controlled trials (RCTs) of GAD were considered to be included in this meta-analysis. All RCTs of quetiapine in GAD patients providing endpoint outcomes relevant to severity of anxiety, response rate, remission rate, overall discontinuation rate, or discontinuation rate due to adverse events were included. The version reports from suitable clinical studies were explored, and the important data were extracted. Measurement for efficacy outcomes consisted of the mean-changed scores of the rating scales for anxiety, and response rate.

Results: A total of 2,248 randomized participants in three RCTs were included. The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs). Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release) were better than those of the placebo. Their response and remission rates were comparable to SSRIs. The rates of pooled overall discontinuation and discontinuation due to adverse events of quetiapine-XR were greater than placebo. Only the overall discontinuation rate of quetiapine-XR at 50 and 150 mg/day and the discontinuation rate due to adverse events of quetiapine-XR at 50 mg/day were comparable to SSRIs.

Conclusion: Based on this meta-analysis, quetiapine-XR is efficacious in the treatment of GAD in adult patients. Despite its low acceptability and tolerability, the use of 50-150 mg/day quetiapine-XR for adult GAD patients may be considered as an alternative treatment. Further well-defined studies should be conducted to warrant these outcomes.

Keywords: acceptability; efficacy; generalized anxiety disorder; quetiapine; tolerability.

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Figures

Figure 1
Figure 1
The flow diagram of the study. Abbreviation: EU-CTR, EU Clinical Trials Register.
Figure 2
Figure 2
The forest plot of comparison of the mean changes from the baseline of the HAM-A scores (95% confidence interval) of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release.
Figure 3
Figure 3
The forest plot of comparison of relative risks (95% confidence interval) for the clinical response rates of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.
Figure 4
Figure 4
The forest plot of comparison of relative risks (95% confidence interval) for the clinical remission rates of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.
Figure 5
Figure 5
The forest plot of comparison of the mean changes from the baseline of the CGI-S scores (95% confidence interval) of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; CGI-S, Clinical Global Impression-Severity; XR, extended-release.
Figure 6
Figure 6
The forest plot of comparison of relative risks (95% confidence interval) for the clinical improvement rate (CGI-I =1, 2) of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; CGI-I, Clinical Global Impression-Improvement; XR, extended-release.
Figure 7
Figure 7
The forest plot of comparison of the mean changes from the baseline of the HAM-A scores (95% confidence interval) of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; HAM-A, Hamilton Anxiety Rating Scale; SSRIs, selective serotonin reuptake inhibitors.
Figure 8
Figure 8
The forest plot of comparison of relative risks (95% confidence interval) for the clinical response rates of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 9
Figure 9
The forest plot of comparison of relative risks (95% confidence interval) for the clinical remission rates of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 10
Figure 10
The forest plot of comparison of the mean changes from the baseline of the CGI-S scores (95% confidence interval) of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; CGI-S, Clinical Global Impression-Severity; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 11
Figure 11
The forest plot of comparison of relative risks (95% confidence interval) for the clinical improvement rate (CGI-I =1, 2) of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; CGI-I, Clinical Global Impression-Improvement; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 12
Figure 12
The forest plot of comparison of the mean changes from the baseline of the PSQI scores (95% confidence interval) of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; PSQI, Pittsburgh Sleep Quality Index.
Figure 13
Figure 13
The forest plot of comparison of the mean changes from the baseline of the PSQI scores (95% confidence interval) of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; PSQI, Pittsburgh Sleep Quality Index; SSRIs, selective serotonin reuptake inhibitors.
Figure 14
Figure 14
The forest plot of comparison of the mean changes from the baseline of the MADRS scores (95% confidence interval) of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; MADRS, Montgomery–Åsberg Depression Rating Scale; SD, standard deviation; XR, extended-release.
Figure 15
Figure 15
The forest plot of comparison of the mean changes from the baseline of the MADRS scores (95% confidence interval) of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; MADRS, Montgomery–Åsberg Depression Rating Scale; SD, standard deviation; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 16
Figure 16
The forest plot of comparison of relative risks (95% confidence interval) for the overall discontinuation rate of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.
Figure 17
Figure 17
The forest plot of comparison of relative risks (95% confidence interval) for the overall discontinuation rate of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.
Figure 18
Figure 18
The forest plot of comparison of relative risks (95% confidence interval) for the discontinuation rate due to adverse events of quetiapine vs placebo in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.
Figure 19
Figure 19
The forest plot of comparison of relative risks (95% confidence interval) for the discontinuation rate due to adverse events of quetiapine vs SSRIs in GAD. Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; SSRIs, selective serotonin reuptake inhibitors.
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