Quetiapine as an adjunctive pharmacotherapy for the treatment of non-remitting generalized anxiety disorder: A flexible-dose, open-label pilot trial

Katzman, Martin A.; Vermani, Monica; Jacobs, Leslie; Marcus, Madalyn; Kong, Bo-Geum; Lessard, Sarah J.; Galarraga, W.; Struzik, Lukasz; Gendron, Alain

doi:10.1016/j.janxdis.2008.03.002

Cited by 50 publications

(33 citation statements)

References 32 publications

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“…These studies ranged from 6 to 12 weeks in duration and contained between 9 and 40 patients. One study examined quetiapine, 25 1 examined risperidone, 26 3 examined aripiprazole, 27Y29 and 1 examined ziprasidone. 30 Response rates ranged from 54% to 75%, remission rates ranged from 11% to 72%, average weight gain from 0.2 to 3.9 lb, and effect sizes for total decrease in HAM-A score from baseline were large, ranging from 0.81 to 2.29.…”

Section: Sga Augmentation For Refractory Gadmentioning

confidence: 99%

Treating Generalized Anxiety Disorder With Second Generation Antipsychotics

Lalonde

Lieshout²

2011

Journal of Clinical Psychopharmacology

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Most individuals with generalized anxiety disorder (GAD) fail to achieve remission despite standard treatments. As a result, we examined the efficacy and tolerability of second-generation antipsychotics (SGAs) as (a) augmentation or (b) monotherapy for GAD. We searched MEDLINE, EMBASE, PsycINFO, the Cochrane Library, controlled trials databases, and the abstracts of scientific meetings for all trials of GAD treatment with SGAs in adults. Randomized, double-blind, parallel-group trials examining SGA augmentation and monotherapy were meta-analyzed. Five augmentation studies containing 912 adults with refractory GAD indicated that SGA augmentation was not more likely to produce clinical response or remission than placebo and was associated with an increased risk of all-cause discontinuation (relative risk [RR] = 1.43; 95% confidence interval [CI], 1.04-1.96). There was no difference in the Hamilton Anxiety Rating Scale on change from baseline or weight gain between groups. Four SGA monotherapy studies containing 1383 patients with GAD indicated that treatment with 150 mg of quetiapine was more likely to lead to a clinical response (RR = 1.31; 95% CI, 1.20-1.44), remission (RR = 1.44; 95% CI, 1.23-1.68), and a greater decrease in the Hamilton Anxiety Rating Scale score (-3.66; 95% CI, -5.13 to -2.19) than placebo. However, an increased risk of all-cause discontinuation (RR = 1.30; 95% CI, 1.09-1.54) and weight gain (2.2 lb; 95% CI, 1.16-3.24) was observed. Existing data suggest that SGAs are not superior to placebo as augmentation for refractory GAD. Quetiapine monotherapy is more efficacious than placebo for uncomplicated GAD, but issues with adverse effects and tolerability may limit its use.

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Section: Sga Augmentation For Refractory Gadmentioning

confidence: 99%

Treating Generalized Anxiety Disorder With Second Generation Antipsychotics

Lalonde

Lieshout²

2011

Journal of Clinical Psychopharmacology

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“…While an augmentation study with a small sample size (6/11 patients completed) reported no additional benefit when quetiapine was added to paroxetine controlled release (Simon et al 2008), other studies have reported positive efficacy results for quetiapine as either monotherapy or adjunct therapy in patients with GAD (Adson et al 2004 ;Galynker et al 2005 ;Katzman et al 2008b). This study evaluated the efficacy and tolerability of quetiapine XR as once-daily monotherapy for GAD.…”

Section: Introductionmentioning

confidence: 98%

Extended-release quetiapine fumarate (quetiapine XR): a once-daily monotherapy effective in generalized anxiety disorder. Data from a randomized, double-blind, placebo- and active-controlled study

Bandelow

Chouinard

Bobes

et al. 2009

Int. J. Neuropsychopharm.

126

113

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The efficacy and tolerability of extended-release quetiapine fumarate (quetiapine XR) once-daily monotherapy in generalized anxiety disorder (GAD) was assessed. This multicentre, double-blind, randomized, placebo- and active-controlled, phase III trial consisted of a 1- to 4-wk enrolment/wash-out period and a 10-wk (8-wk active treatment, 2-wk post-treatment drug-discontinuation) study period; 873 patients were randomized to 50 mg or 150 mg quetiapine XR, 20 mg paroxetine, or placebo. Primary endpoint was change from randomization at week 8 in Hamilton Rating Scale for Anxiety (HAMA) total score. At week 8, all active agents produced significant improvements in HAMA total and psychic subscale scores vs. placebo; HAMA somatic subscale scores were significantly reduced only by 150 mg quetiapine XR. Significant separation from placebo (-2.90) in HAMA total score was observed at day 4 for 50 mg quetiapine XR (-4.43, p<0.001) and 150 mg quetiapine XR (-3.86, p<0.05), but not for paroxetine (-2.69). Remission (HAMA total score 7) rates at week 8 were significantly higher for 150 mg quetiapine XR (42.6%, p<0.01) and paroxetine (38.8%, p<0.05) vs. placebo (27.2%). The most common adverse events (AEs) were dry mouth, somnolence, fatigue, dizziness, and headache, for quetiapine XR, and nausea, headache, dizziness for paroxetine. A lower proportion of patients reported sexual dysfunction with quetiapine XR [0.9% (50 mg), 1.8% (150 mg)] than with placebo (2.3%) or paroxetine (7.4%). The incidence of AEs potentially related to extrapyramidal symptoms was: quetiapine XR: 50 mg, 6.8%, 150 mg, 5.0%; placebo, 1.8%; and paroxetine, 8.4%. Once-daily quetiapine XR is an effective and generally well-tolerated treatment for patients with GAD, with symptom improvement seen as early as day 4.

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“…Response to these treatments tends to be highly variable, ranging from 40% to 70% (Baldwin and Nair, 2005;Gelenberg et al, 2000;Pollack et al, 2001;Rickels et al, 1993). Furthermore, limits in terms of efficacy and tolerability often result in poor patient adherence to medication and thus, long-term remission is often difficult to achieve (Katzman et al, 2008). On average, only a third of GAD patients achieve remission within a year of follow-up, while patients who do achieve an initial response often relapse (Andrews et al, 2000).…”

Section: Introductionmentioning

confidence: 99%