惊恐障碍急性期药物治疗和认知行为治疗及两者联合治疗疗效比较的网络 Meta 分析

Object This study aims to compare the efficacy, acceptability and tolerability of cognitive behavior therapy (CBT), pharmacotherapy, and their combination therapy for acute panic disorder via network Meta-analysis. Methods Electronic databases including PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for relevant randomized controlled clinical trials from their inception up to March 24, 2021. The outcomes were efficacy (remission rate and response rate), acceptability and tolerability. Network Meta-analysis was adopted with random effects, and estimated relative risk (RR) for all effects of CBT, CBT plus medications, selective serotonin-reuptake inhibitors(SSRIs), serotonin-noradrenaline-reuptake inhibitors(SNRIs), tricyclic antidepressants(TCAs), monoamine oxidase inhibitors(MAOI), benzodiazepines(BZD), noradrenergic-reuptake inhibitors(NRI), and others. This study used gemtc package in R for network analysis, Review Manager for quality assessment, and GRADEPro for evidence assessment, respectively. Results Identified citations (7 173) included 72 trials comprising 12 293 patients. The treatment measures with higher remission rate and response rate than placebo included CBT+drug(RR:2.4, 95%CI: 1.7-3.5), CBT(RR:1.8, 95%CI:1.4-2.3), SNRI(RR:1.8, 95%CI: 1.5-2.2), BZD(RR: 1.6, 95%CI: 1.4-1.9), SSRI(RR: 1.5, 95%CI: 1.4-1.7), TCA(RR: 1.5, 95%CI: 1.4-1.8)(remission rate in brackets); Among them, CBT combined with medications was better than SSRI, SNRI and TCA. The acceptability of BZD was better than placebo but its tolerability was inferior. Besides, the tolerability of SSRI and TCA was inferior to placebo. Conclusions CBT combined with medications is more effective than BZD alone and the antidepressants alone. CBT combined with medications may selected the first-line treatment for panic disorder.