Clinical outcomes of recommended active pharmacotherapy agents from NICE guideline for post-traumatic stress disorder: Network meta-analysis

Abstract

BackgroundPost-traumatic stress disorder (PTSD) is a mental disorder that can emerge after an individual experiences a traumatic event such as physical abuse, sexual/relationship violence, combat exposure, witnessing death, or serious injury. This study aimed to identify the most suitable drugs for the management of PTSD based on a network meta-analysis (NMA). MethodsSix databases (Ovid Medline, EMBase, CENTRAL, PsycINFO, Ovid Health and Psychosocial Instruments, and Web of Science) were searched from inception to September 6, 2022. ResultsThirty articles with a total of 5170 participants were included. Compared with placebo, active drugs including olanzapine (SMD = −0.66, 95% CI: −1.19 to −0.13), risperidone (SMD = −0.23, 95% CI: −0.42 to −0.03), quetiapine (SMD = −0.49, 95% CI: −0.93 to −0.04), venlafaxine (SMD = −0.29, 95% CI: −0.42 to −0.16), sertraline (SMD = −0.23, 95% CI: −0.34 to −0.11), paroxetine (SMD = −0.48, 95% CI: −0.60 to −0.36) and fluoxetine (SMD = −0.27, 95% CI: −0.42 to −0.12), significantly reduced the total clinician-administered PTSD scale score. ConclusionThe results of this study support the use of paroxetine, venlafaxine, and quetiapine as first-line treatment for PTSD. In addition, quetiapine is recommended for patients with PTSD affected by symptoms of hyperarousal and re-experience disorder. Clinicians should prescribe medications based on the severity of PTSD symptoms and other conditions to develop the best treatment strategy for this patient population.