Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder: 2024 Update of the Evidence Base for the PTSD Trials Standardized Data Repository [Internet]

Excerpt

Objectives: Identify and abstract data from randomized controlled trials (RCTs) examining treatment for posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder to update the previous Agency for Healthcare Research and Quality (AHRQ) report on this topic and the National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD Repository) with newly included trials.

Data sources: We searched PTSDpubs, Ovid^® MEDLINE^®, Cochrane CENTRAL, PsycINFO^®, Embase^®, CINAHL^®, and Scopus^® for eligible RCTs published from March 1, 2023, to April 1, 2024.

Review methods: In consultation with AHRQ and NCPTSD, we updated the evidence tables for the PTSD Repository by including evidence published after publication of the last update and studies that met updated inclusion criteria for the database (e.g., interventions that do not require a provider). Evidence tables were also updated with calculated standardized effect sizes for continuous PTSD outcomes for all included studies. We assessed risk of bias (RoB) for all included studies using the Revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials.

Results: We added 54 RCTs examining treatments for PTSD, for a total of 550 included trials published from 1988 to April 1, 2024. Among all 550 included RCTs, studies of psychotherapy interventions were the most common (47%), followed by pharmacologic interventions (17%). Most studies were conducted in the United States (58%) and had sample sizes ranging from 25 to 99 participants (59%). Approximately half of the studies enrolled community (i.e., not specifically military) participants (54%), and most were conducted in outpatient settings (78%). Studies typically enrolled participants with a mix of trauma types (52%). Among all 550 included RCTs, RoB was rated as low for 18 percent of studies, 27 percent were rated as having some concerns, and the remaining 54 percent were rated as high RoB.

Among the 54 newly added RCTs, psychotherapy interventions were the most commonly employed (44%), followed by pharmacotherapy (13%) and nonpharmacologic cognitive interventions (11%). Approximately half of the studies were conducted in the United States (48%), and enrolled community participants (54%) and participants with a mix of trauma types (56%). Studies typically had sample sizes ranging from 25 to 99 participants (61%). Of the newly added RCTs, RoB was rated as low for 39 percent of studies, 17 percent were rated as having some concerns, and the remaining 44 percent were rated as high RoB.

Conclusions: This report updates the previous AHRQ report to add 54 RCTs, for a total of 550 trials. This update adds comprehensive data and RoB assessment for the newly included RCTs, and standardized effect sizes for continuous PTSD outcomes for all included studies. As with the previous AHRQ update, this report will serve as the updated evidence base for the PTSD Repository, a comprehensive database of PTSD trials.