Como, Italy—Despite the use of medications as first-line treatments for panic disorder (PD), as many as 64% of patients don’t have adequate response or complete resolution of symptoms, including panic attacks, a new study points out.
The new analysis, published recently in Personalized Medicine in Psychiatry, looks at scientific data to determine whether easily identified patient characteristics can help select the optimal medication for each patient.
“The major goal of a personalized treatment approach is to tailor interventions according to each patient’s unique profile and characteristics,” explained lead investigator Daniela Caldirola, MD, PhD, of the Department of Clinical Neurosciences, Hermanas Hospitalarias in Como, Italy, “Although still a challenging issue for clinicians, a personalized approach, based on reliable predictors of pharmacotherapy course, may provide relevant advances in the treatment of psychiatric disorders. PD, a common and debilitating psychiatric condition, could greatly benefit from such an approach, because from a clinical perspective there is still a strong unmet need for more efficacious pharmacological interventions in this disorder.”
Currently used in treating the condition are selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines, according to the report.
Researchers identified 22 randomized, placebo-controlled studies of three drugs—paroxetine, venlafaxine XR, and alprazolam—to identify sociodemographic and clinical characteristics that can be easily evaluated in clinical practice before treatment initiation. Those include gender, age, duration of PD, the presence/severity of agoraphobia; number of panic attacks; severity of the disorder, and severity of general anxiety/depressive symptoms. Clinical outcomes and tolerability of FDA-approved medications for PD also were taken into consideration, study authors add.
“To the best of our knowledge, this is the first meta-analysis with this aim,” Caldirola said. “In case of significant results, clinicians could use these variables as predictive tools to maximize therapeutic efficacy and minimize side effects of anti-panic treatments according to each patient's characteristics.”
Three key correlations were determined in the study:
• Longer illness duration was significantly associated with lower rate of patients free from PAs at the end of trials that compared venlafaxine XR to placebo
• Higher age at the beginning of trials that compared paroxetine to placebo was significantly associated with higher rate of patients who dropped out of the studies because of adverse side effects, and
• The longer the treatment, the higher the rate of patients free from PAs at the endpoint of RCTs with venlafaxine XR.
“Our research does underscore the fact that, in the realm of pharmacotherapy for PD, reliable conclusions regarding the usefulness of sociodemographic and clinical variables as moderators of outcomes cannot yet be drawn,” Caldirola noted, emphasizing that a personalized approach, although still at an early stage, appears to be a promising route to successful outcomes.
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Published May 10, 2017