Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness
Por:
Cardoner, N, Gutiérrez-Rojas, L, Saiz, P, Lahera, G, alvarez-Mon, MA, Ortega, PA, Pérez-Páramo, M
Publicada:
7 feb 2025
Resumen:
Introduction: Generalized Anxiety Disorder (GAD) is a mental health condition with a recent increase in prevalence. GAD is often underdiagnosed, leading to negative consequences for individuals, healthcare systems, and society. The economic burden and impaired quality of life associated with GAD underscores the need for effective treatment. Pregabalin has shown promise in reducing anxiety symptoms; however, further research is needed to evaluate its efficacy and compare it with other treatment options. This study aimed to assess the efficacy, safety, and optimal pregabalin dosage for the treatment of GAD. Methods: This meta-analysis followed PRISMA guidelines. Pregabalin-treated patients comprised the intervention group, whereas the comparator group received benzodiazepines, SSRIs, SNRIs, or placebo. Efficacy and safety were evaluated using various scales and adverse events (AEs). Randomized clinical trials were included in the study. Four major databases were used for this study. Outcome measures included the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Improvement Scale (CGI-I), discontinuation rates, costs, and quality-adjusted life-years (QALYs). Meta-analyses were conducted using Review Manager 5.4 software, employing odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed based on follow-up and dosage. Results: Fourteen studies involving 4,822 patients were analyzed. Pregabalin demonstrated superior efficacy in reducing HAM-A global scores at 2 weeks (MD -1.23, 95% CI -1.79 to -0.66), 4 weeks (MD -1.12, 95% CI -1.60 to -0.63), 8 weeks (MD -2.50, 95% CI -4.21 to -0.79), 12 weeks (MD 0.99, 95% CI 0.35-1.63), and 6 months to 1 year (MD -3.31, 95% CI -4.30 to -2.31). Pregabalin also showed a higher response rate to HAM-A (OR 1.51, 95% CI 1.31 1.75). CGI-I scores favored pregabalin (MD -0.25, 95% CI -0.38 to -0.12), with a higher response rate (OR 1.33, 95% CI 1.15-1.55). The discontinuation rates were lower with pregabalin (OR 0.80, 95% CI 0.70, 0.91). Adverse events favored pregabalin over SSRIs/SNRIs and benzodiazepines at different doses. Pregabalin was associated with higher cost-effectiveness (MD 0.02, 95% CI 0.01, 0.03). Conclusion: Pregabalin is an effective and well-tolerated treatment for generalized anxiety disorder, showing superior efficacy and safety compared with first-line medications.
Filiaciones:
Cardoner, N:
Hosp Santa Creu & Sant Pau, Dept Paediat, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Inst Invest Biomed St Pau IIB St Pau, Barcelona 08025, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Univ Autonoma Barcelona, Sch Med Bellaterra, Dept Psychiat & Forens Med, Barcelona, Spain
Gutiérrez-Rojas, L:
Univ Granada, Dept Psychiat, Granada, Spain
Univ Granada, Inst Neurosci, CTS Res Grp 549, Granada, Spain
Saiz, P:
Univ Oviedo, Dept Psychiat, Oviedo, Spain
Inst Salud Carlos III, CIBER Salud Mental, Madrid, Spain
Inst Invest Sanitaria Principado Asturias ISPA, Oviedo, Spain
Inst Univ Neurociencias Principado Asturias INEURO, Oviedo, Spain
Serv Salud Principado Asturias SESPA Oviedo, Oviedo, Spain
Lahera, G:
Inst Salud Carlos III, CIBER Salud Mental, Madrid, Spain
Univ Alcala, Dept Psychiat, Madrid, Spain
Principe Asturias Univ Hosp, Oviedo, Spain
Inst Invest Sanitaria Ramon & Cajal IRyCIS, Madrid, Spain
alvarez-Mon, MA:
Hosp Univ Infanta Leonor, Dept Psychiat & Mental Hlth, Madrid, Spain
Univ Alcala, Dept Med & Med Specialties, Alcala De Henares, Spain
Ramon & Cajal Inst Sanitary Res IRYCIS, Madrid, Spain
Inst Salud Carlos III, CIBER Salud Mental, Madrid, Spain
Ortega, PA:
Inst Salud Carlos III, CIBER Salud Mental, Madrid, Spain
Hosp Bellvitge Princeps Espanya, Dept Psychiat, Barcelona, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona, Spain
Univ Barcelona, Dept Clin Sci, Barcelona, Spain
Pérez-Páramo, M:
Viatris, Med Dept, Madrid, Spain
Green Submitted, gold
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