比较药物治疗儿童和青少年焦虑症的有效性和可接受性混合处理比较荟萃分析.doc

比较药物治疗儿童和青少年焦虑症的有效性和可接受性： 混合处理比较荟萃分析Olalekan A. Uthman and Jibril Abdulmalik 目的： 比较不同药物治疗儿童和青少年焦虑症的有效性和可接受性 方法： 更新了最近进行的关于药物治疗儿童和青少年焦虑症的Cochrane综述。采用Bayesian Markov Chain Monte Carlo 模拟进行混合处理比较荟萃分析，用于间接比较。我们采用安慰剂作对照，计算了有95％可信区间（CrI ）的相对风险比（RR）。 结果：数据由16个临床试验总结而成，在试验中将儿童随机分成六个不同的给药组（包括安慰剂组）。氟西汀组、氟伏沙明组、帕罗西汀组、舍曲林组和文拉法辛组比安慰剂组有效。文拉法辛的有效性显著低于氟伏沙明（RR=0.60;95％CRI 0.35-0.95）和帕罗西汀（RR=0.65;95％CRI 0.44-0.93）。氟西汀、氟伏沙明、帕罗西汀和舍曲林的可接受性高于安慰剂。文拉法辛耐受性低于氟伏沙明（RR= 0.16;95％ CRI0.01-0.64）、帕罗西汀（RR=0.21;95％ CRI 0.05-0.59）和舍曲林（RR=0.31;95％ CRI 0.08-0.83）。氟伏沙明的临床效果和可接受性的比例高于其他治疗组，分别为47.5％和50.6％，为最有效且耐受性良好的治疗组。 结论：治疗儿童焦虑症药物的有效性和可接受性在临床上存在重要差异，其中以氟伏沙明的有效性和可接受性最好。开始治疗儿童和青少年焦虑症时，综合考虑药物的效果和可接受性，最好选择氟伏沙明。Comparative efficacy and acceptability ofpharmacotherapeutic agents for anxiety disorders in children and adolescents:a mixed treatment comparison meta-analysis Olalekan A. Uthman and Jibril Abdulmalik [Abstract] Objective: to compare efficacy and acceptability of different pharmacotherapeutic agents for treating anxiety disorders in children and adolescents Methods: A recently conducted Cochrane Review on pharmacotherapy for anxiety disorders in children and adolescents was updated. A mixed treatment comparison meta-analysis using Bayesian Markov Chain Monte Carlo simulation was used to perform the indirect comparison. We calculated relative risk ratios (RR) with 95% credible interval (CrI) using placebo as the common comparator. Results: Data were combined from 16 clinical trials that randomized children to six different treatment strategies, including placebo. Fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine were more efficacious than placebo. Venlafaxine was significantly less efficacious than fluvoxamine (RR ? 0.60; 95% CrI 0.35–0.95) and paroxetine (RR ? 0.65; 95% CrI 0.44–0.93). Fluoxetine, fluvoxamine, paroxetine, and sertraline had higher acceptability profile than placebo. Venlafaxine was less tolerated than fluvoxamine (RR ? 0.16;95% CrI 0.01–0.64), paroxetine (RR ? 0.21;