Short-term efficacy and tolerability of venlafaxine extended release in adults with generalized anxiety disorder without depression: A meta-analysis

Abstract

BackgroundAlthough efficacy of venlafaxine extended release (XR) for generalized anxiety disorder (GAD) has been reported in previous analyses in 2002 and 2004, the sample size was rather small and estimate of safety or tolerability was not clear. The present analysis had the advantage of large sample size and provided evidence for tolerability.MethodsLiterature databases were searched, including Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of science and clinical trials. 10 eligible articles were finally selected and data was extracted and logged into the Review Manager 5.3 by two independent authors. The risk of bias was evaluated by the Cochrane Collaboration’s Risk of Bias Tool and the stability of the results was assessed by sensitivity analysis. The publication bias was assessed by funnel plot and Egger’s/Begg’s test using Stata Version 12.0 software.ResultsIn the current meta-analysis, 10 articles (14 studies) satisfying the inclusion criteria were analyzed. As efficacy outcomes, our findings indicated venlafaxine XR was significantly more effective than placebo according to mean change of the Hamilton Rating Scale for Anxiety total scores [mean difference = 3.31, 95% confidence interval(CI) 1.44–5.18, P = 0.0005], response [odds ratio(OR) = 1.83, 95%CI 1.58–2.12, P<0.00001], and remission (OR = 2.55, 95%CI 1.36–4.78, P = 0.003). In terms of tolerability, the most frequently reported treatment-emergent adverse events were nausea, dry mouth, dizziness, insomnia, somnolence, and headache. In addition, discontinuation due to all-cause (OR = 1.17, 95%CI 0.92–1.49, P = 0.19) was not significantly different between the two groups, whereas discontinuation due to adverse events was statistically higher in the venlafaxine XR group compared with the placebo treatment (OR = 2.80, 95%CI 2.21–3.54, P<0.00001) and discontinuation due to inefficacy was lower in venlafaxine than placebo treatment (OR = 0.26, 95%CI 0.17–0.40, P<0.00001). There was no significant publication bias and sensitivity analysis showed that our analysis exhibited high stability.ConclusionWe concluded that venlafaxine XR (75–225 mg/day) is an effective and well-tolerated pharmacological treatment option for adult patients with GAD.

Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder

“…[ 18 ] A random-effects model was used to pool data with substantial heterogeneity. Publication bias was assessed by a funnel plot and Egger test [ 19 ] using Stata Version 12.0 software. We also conducted sensitivity analyses to evaluate the stability of the main outcomes.…”

Toward a paradigm shift in treatment and research of mental disorders

“…Recent high-ranking meta-analyses suggest that the efficacy of psychotherapy and pharmacotherapy in comparison to placebo or TAU is limited. For key mental disorders such as depressive disorders (Driessen et al ., 2015; Cipriani et al ., 2018; Cuijpers et al ., 2019), anxiety disorders (Heeren et al ., 2015; Curtiss et al ., 2017; Li et al ., 2017; Liu et al ., 2017; Carpenter et al ., 2018; Gomez et al ., 2018), somatoform disorders (van Dessel et al ., 2014), borderline personality disorder (Cristea et al ., 2017a), bipolar disorder (Cipriani et al ., 2013), schizophrenia spectrum disorders (Jauhar et al ., 2014; Leucht et al ., 2017), and psychotherapy of children and adolescents (Weisz et al ., 2006, 2013, 2017, 2019; Eckshtain et al ., 2019), psychotherapy and pharmacotherapy yielded effect sizes in terms of standardized mean differences (SMDs) of about 0.30 or below in comparison with TAU or placebo, especially if effect sizes were adjusted for biases (Leucht et al ., 2017; Gomez et al ., 2018; Cuijpers et al ., 2019). Large effect sizes (⩾0.80) were only achieved in comparison of psychotherapy to weak comparators such as waiting list conditions (Huhn et al ., 2014; Cuijpers et al ., 2016; Liu et al ., 2017).…”

“…Rates for remission and response were found to be limited as well. For depressive and anxiety disorders, meta-analyses reported rates of remission between 37% and 43% (Cuijpers et al ., 2014; Li et al ., 2017; Springer et al ., 2018). For schizophrenia, a recovery rate of 23% was found (Leucht, 2014).…”

Efficacy and tolerability of short-term duloxetine treatment in adults with generalized anxiety disorder: A meta-analysis

“…Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous variables, and odds ratios (ORs) with 95% CIs were calculated for dichotomous variables. A random-effects model was used to pool studies with substantial heterogeneity, as determined by the chi-squared test (P<0.05) and the inconsistency index (I 2 ≥ 50%) [ 20 – 21 ]. Publication bias was assessed with funnel plots and the Begg’s/Egger’s test[ 22 – 23 ] using Stata 12.0 software.…”