Clinical outcomes of recommended active pharmacotherapy agents from NICE guideline for post-traumatic stress disorder: Network meta-analysis

• Published in: Progress in neuro-psychopharmacology & biological psychiatry 2023-07, Vol.125, p.110754-110754, Article 110754
• Main Authors: Zhang, Zhi-Xin, Liu, Run-Ben, Zhang, Jin, Xian-Yu, Chen-Yang, Liu, Jia-Ling, Li, Xiao-Zheng, Zhang, Yu-Qiang, Zhang, Chao
• Format: Article
• Language: English
• Subjects: Cognitive Behavioral Therapy - methods; Humans; Network Meta-Analysis; Paroxetine; Post-traumatic stress disorder; Quetiapine; Quetiapine Fumarate - therapeutic use; Stress Disorders, Post-Traumatic - diagnosis; Total clinician administered PTSD scale; Venlafaxine; Venlafaxine Hydrochloride - therapeutic use
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2023.110754

Post-traumatic stress disorder (PTSD) is a mental disorder that can emerge after an individual experiences a traumatic event such as physical abuse, sexual/relationship violence, combat exposure, witnessing death, or serious injury. This study aimed to identify the most suitable drugs for the management of PTSD based on a network meta-analysis (NMA). Six databases (Ovid Medline, EMBase, CENTRAL, PsycINFO, Ovid Health and Psychosocial Instruments, and Web of Science) were searched from inception to September 6, 2022. Thirty articles with a total of 5170 participants were included. Compared with placebo, active drugs including olanzapine (SMD = −0.66, 95% CI: −1.19 to −0.13), risperidone (SMD = −0.23, 95% CI: −0.42 to −0.03), quetiapine (SMD = −0.49, 95% CI: −0.93 to −0.04), venlafaxine (SMD = −0.29, 95% CI: −0.42 to −0.16), sertraline (SMD = −0.23, 95% CI: −0.34 to −0.11), paroxetine (SMD = −0.48, 95% CI: −0.60 to −0.36) and fluoxetine (SMD = −0.27, 95% CI: −0.42 to −0.12), significantly reduced the total clinician-administered PTSD scale score. The results of this study support the use of paroxetine, venlafaxine, and quetiapine as first-line treatment for PTSD. In addition, quetiapine is recommended for patients with PTSD affected by symptoms of hyperarousal and re-experience disorder. Clinicians should prescribe medications based on the severity of PTSD symptoms and other conditions to develop the best treatment strategy for this patient population. •Paroxetine, venlafaxine and quetiapine should be as first-line treatment for PTSD.•Quetiapine reduced the symptoms of hyperarousal and re-experience disorder.•Various sub-symptomatic manifestations should guide clinical medication use.