Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder: preliminary findings

Simon, Naomi M.; Connor, Kathryn M.; LeBeau, Richard T.; Hoge, Elizabeth A.; Worthington, John J.; Zhang, Wei; Davidson, Jonathan; Pollack, Mark H.

doi:10.1007/s00213-008-1087-x

Cited by 63 publications

(53 citation statements)

References 38 publications

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“…23 The extent of quetiapine use to treat anxiety is unprecedented for an antipsychotic. Although several small randomized trials 24,25 were completed and published earlier, the first large randomized controlled trial (RCT) of quetiapine for anxiety was published in a peer-reviewed journal in 2010 26 followed by 4 others [27][28][29][30] in the following years. A systematic review 31 of RCTs of quetiapine for anxiety found it to be clinically efficacious for generalized anxiety; however, its overall tolerability was poor.…”

Section: Discussionmentioning

confidence: 99%

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

Pringsheim

Gardner

2014

CMAJ Open

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Section: Discussionmentioning

confidence: 99%

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

Pringsheim

Gardner

2014

CMAJ Open

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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: 93%

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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“…1i). Four studies 33,34,36,37 provided data on remission for 835 individuals. In these trials, the SGAs failed to demonstrate superiority to placebo (RR = 1.28; 95% CI, 0.96Y1.71; Fig.…”

Section: Primary Outcomesmentioning

confidence: 99%

“…Of the 5 included trials, 1 examined olanzapine, 33 2 examined risperidone, 34,35 and 2 examined quetiapine. 36,37 These studies included data on 912 patients and lasted 5 to 8 weeks. All studies included patients with a primary diagnosis of GAD, which the authors labeled refractory.…”

Section: Randomized Double-blind Placebo-controlled Studiesmentioning

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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Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder: preliminary findings

Cited by 63 publications

References 38 publications

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

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

Treating Generalized Anxiety Disorder With Second Generation Antipsychotics

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