PMID- 35115944
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220205
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 12
DP  - 2021
TI  - Effectiveness, Acceptability and Safety of Pharmaceutical Management for 
      Combat-Related PTSD in Adults Based on Systematic Review of Twenty-Two Randomized 
      Controlled Trials.
PG  - 805354
LID - 10.3389/fphar.2021.805354 [doi]
LID - 805354
AB  - Objective: This study assessed the efficacy, acceptability, and safety of 
      pharmaceutical management for combat-related post-traumatic stress disorder 
      (PTSD) to provide a clinical decision-making basis for clinicians. Method: A 
      comprehensive search was conducted using Ovid MEDLINE, Ovid EMBASE, Cochrane 
      Library, Scopus, ScienceDirect, and Web of Science for randomized controlled 
      trails (RCTs), which reported pharmaceutical management and placobo for adults 
      with combat-related PTSD, that were published until April 21, 2021. The 
      effectiveness, acceptability, and adverse events (AEs), were designed as 
      interested outcomes. The change in total symptoms of combat-related PTSD 
      according to the clinician rating scale was defined as primary outcome, and the 
      others were defined as secondary outcomes. Results: Twenty-two RCTs with 1,221 
      patients were involved. Compared with placebo, overall active comparators had 
      statistical differences for all outcomes, including the change in total symptoms 
      of combat-related PTSD [SMD = -0.36, 95%CI (-0.62,-0.09)], depression [SMD = 
      -0.28, 95%CI (-0.45,-0.10)], anxiety [SMD = -0.44, 95%CI (-0.64,-0.23)], 
      re-experience [SMD = -0.33, 95%CI (-0.52,-0.13)], avoidance [SMD = -0.24, 95%CI 
      (-0.43,-0.05)], and hyper-arousal [SMD = -0.26, 95%CI (-0.48,-0.03)]. Compared 
      with the placebo, in terms of acceptability, overall active comparators did not 
      significantly decrease all-cause discontinuance rates [RR = 0.97, 95%CI 
      (0.78,1.20)], and the significance decreased due to AEs [RR = 2.42, 95%CI 
      (1.41,4.13)]. Nevertheless, overall there was no statistically significant 
      difference for overall AEs, including somnolence, sedation, dizziness, 
      paresthesia, anxiety, blurred vision, generalized anxiety disorder, and sleep 
      disturbance. All funnel plots were symmetrical and no publication bias was found. 
      Conclusion: Active drugs, especially amitriptyline, imipramine, and quetiapine, 
      had a positive effect on the improvement of combat-related PTSD symptoms. Despite 
      there being no significant increase in the AEs of the active drugs, the fact that 
      the discontinuation rates of these drugs, including risperidone, imipramine, and 
      topiramate, were increased deserves attention. Furthermore, as active drugs were 
      effective across ethnic groups and battlefields, active drug regimens were 
      revealed to be more appropriate for treating people with symptoms of extreme 
      severe PTSD (>/=80) or PTSD that is at least 8 weeks old. In addition, current 
      evidence was from adults under 60 years of age and male combat-related PTSD. 
      Whether this evidence can be extended to other populations of combat-related PTSD 
      needs to be confirmed by subsequent high-quality, large-sample studies.
CI  - Copyright (c) 2022 Yan, Liu, Li, Zhang, Liu, Zhang and Gong.
FAU - Yan, Jin-Zhu
AU  - Yan JZ
AD  - Department of Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, 
      China.
FAU - Liu, Jia-Ling
AU  - Liu JL
AD  - Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei 
      University of Medicine, Shiyan, China.
FAU - Li, Xiao-Zheng
AU  - Li XZ
AD  - Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei 
      University of Medicine, Shiyan, China.
FAU - Zhang, Zhi-Xin
AU  - Zhang ZX
AD  - Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei 
      University of Medicine, Shiyan, China.
FAU - Liu, Run-Ben
AU  - Liu RB
AD  - Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei 
      University of Medicine, Shiyan, China.
FAU - Zhang, Chao
AU  - Zhang C
AD  - Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei 
      University of Medicine, Shiyan, China.
FAU - Gong, Qin-Qin
AU  - Gong QQ
AD  - Department of Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, 
      China.
AD  - Center of Women's Health Sciences, Taihe Hospital, Hubei University of Medicine, 
      Shiyan, China.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220118
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC8804358
OTO - NOTNLM
OT  - anxiety
OT  - depression
OT  - pharmacological interventions
OT  - post-traumatic stress disorder
OT  - veterans
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/02/05 06:00
MHDA- 2022/02/05 06:01
PMCR- 2022/01/18
CRDT- 2022/02/04 05:47
PHST- 2021/11/01 00:00 [received]
PHST- 2021/12/20 00:00 [accepted]
PHST- 2022/02/04 05:47 [entrez]
PHST- 2022/02/05 06:00 [pubmed]
PHST- 2022/02/05 06:01 [medline]
PHST- 2022/01/18 00:00 [pmc-release]
AID - 805354 [pii]
AID - 10.3389/fphar.2021.805354 [doi]
PST - epublish
SO  - Front Pharmacol. 2022 Jan 18;12:805354. doi: 10.3389/fphar.2021.805354. 
      eCollection 2021.