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Review: quetiapine monotherapy improves response and remission compared with placebo in generalised anxiety disorder

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Question

Question

Are second-generation antipsychotics (SGAs) effective as monotherapy or adjunctive treatments for maintaining remission in people with generalised anxiety disorder (GAD)?

Outcomes

Efficacy and tolerability of SGAs in treatment of GAD. Primary outcomes were clinical response, remission rates and discontinuation. Response was defined as the proportion of patients with a 50% or greater reduction from the baseline Hamilton Anxiety Rating Scale (HAM-A) score. Individuals with a HAM-A score ≤7 were considered to be in remission.

Methods

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched up to November 2009. Additional studies were also identified through searches of the Current Clinical Trials website and for abstracts from relevant conferences, and by hand searches of reference lists. No exclusions were made on the basis of language.

Study selection and analysis

Eligible studies had to be randomised controlled trials (RCTs) in adults comparing SGAs with active drugs or placebo, where SGAs were either used as monotherapy or adjunctive therapy. Open label uncontrolled studies were also summarised. Studies of patients with Axis I or Axis II comorbidities were included if the primary diagnosis was GAD. Separate meta-analyses …

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Footnotes

  • Sources of funding The first author was funded by a Canadian Institutes of Health Research Fellowship.

Footnotes

  • Competing interests CUC has been a consultant and/or advisor to or has received honoraria from: Actelion, Alexza; AstraZeneca, Biotis, Bristol-Myers Squibb, Cephalon, Eli Lilly, GSK, IntraCellular Therapies; Ortho-McNeill/Janssen/J&J, Medavante, Merck, Novartis, Otsuka, Pfizer and Sunovion. He has received grant support from the Feinstein Institute for Medical Research, the National Institute of Mental Health (NIMH) and the National Alliance for Research in Schizophrenia and Depression (NARSAD), BMS, Otsuka and Ortho-McNeill/Janssen/J&J. MC has no conflicting interests.

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