Agomelatine for the Treatment of Generalized Anxiety Disorder: A Meta-Analysis

Abstract

Objective Despite multiple drugs available, a large proportion of patients with generalized anxiety disorder (GAD) do not show adequate response and remission. Thus, additional novel pharmacological agents are needed to increase treatment option for GAD. We aimed to investigate efficacy and safety of agomelatine in the treatment of GAD by conducting a meta-analysis. Methods An extensive search of multiple databases and clinical trial registries were conducted. Mean change in total scores on Hamilton Anxiety Rating Scale (HAM-A) from baseline to endpoint was our primary outcome measure. Secondary efficacy measures included response and remission rates, as defined by a 50% or greater reduction in HAM-A total scores and a score of 7 or less in HAM-A total scores at study endpoint respectively. Results Four published double blinded, randomized, placebo-controlled trials were included in this meta-analysis. Agomelatine more significantly (standardized mean difference = −0.56, p = 0.004) improved HAM-A total scores than placebo. The odds ratios (ORs) of agomelatine over placebo for response and remission rates were 3.75 ( p < 0.00001) and 2.74 ( p < 0.00001), respectively. Agomelatine was generally well tolerated with insignificance in dropout rate, somnolence, headache, nasopharyngitis, and dizziness compared with placebo. However, agomelatine showed significantly higher incidence of liver function increment (OR = 3.13, p = 0.01) and nausea (OR = 3.27, p = 0.02). Conclusion We showed that agomelatine may be another treatment option in patients with GAD. However, the results should be interpreted and translated into clinical practice with caution because the meta-analysis was based on limited numbers of clinical trials.

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

“…In the largest meta-analyses for anxiety disorders, pharmacotherapies achieved SMDs in comparison to placebo between 0.33 and 0.45 53,56,64 (see Figure 2). Overall, effect sizes for pharmacotherapy were between 0.01 and 0.56, with the majority of effect sizes being small 53,[55][56][57][58][59][60][61][62][63][64]66,67,69,70 (see supplementary information). RR ranged between 1.20 and 4.03, with most values being small, one medium (monoamine oxidase inhibitors), and one large (benzodiazepines, RR=4.03) 69 .…”

Rapid Onset of Intranasal Esketamine in Patients with Treatment Resistant Depression and Major Depression with Suicide Ideation: A Meta-Analysis

“…Although studies confirmed its anti-suicidal effects in patients with MDSI, but whether or not the anti-suicidal effects are rapid is still obscure. In terms of understanding efficacy and safety of a new drug, meta-analysis is important because it can overcome limitation of small sample sizes, increase statistical power of group comparisons, enhance generalizability of DB-RCTs, and quantify inconsistencies of DB-RCTs [ 22 , 23 ]. An initial meta-analysis for intranasal esketamine showed that significant superiority of intranasal esketamine over placebo with regard to response and remission in patients with MDD were noted as early as two hours [ 24 ].…”

The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment

“…In fact, high doses MT may have a beneficial role in patients treated for SARS-CoV-2-induced pneumonia, in terms of reduced time to clinical improvement and even possible lower mortality rates [ 271 ]. Given its inherent anxiolytic and antidepressant properties [ [272] , [273] , [274] ], agomelatine could be a useful medicine to consider in COVID-19 related mood and anxiety disorders.…”