Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder: 2023 Update of the Evidence Base for the PTSD Trials Standardized Data Repository

Abstract

Objectives. Identify and abstract data from randomized controlled trials (RCTs) examining treatment for posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder to update the previous Agency for Healthcare Research and Quality (AHRQ) report on this topic and the National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD-Repository) with newly published trials. Data sources. We searched PTSDpubs, Ovid® MEDLINE®, Cochrane CENTRAL, PsycINFO®, Embase®, CINAHL®, and Scopus® for eligible RCTs published from August 1, 2021, to March 3, 2023. Review methods. In consultation with AHRQ and NCPTSD, we updated the evidence tables for the PTSD-Repository by including evidence published after publication of the last update and expanding abstraction of results to include calculated standardized effect sizes. The primary publication for each RCT was abstracted; data and citations from secondary publications (i.e., companion papers) appear in the same record. We assessed risk of bias (RoB) for all included studies using the Revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials. For studies already in the PTSD-Repository, we will add calculated standardized effect sizes in a future update. Results. We added 60 new RCTs examining treatments for PTSD, for a total of 496 included studies published from 1988 to March 3, 2023. Among all 496 included RCTs, studies of psychotherapy interventions were the most common (44%), followed by pharmacologic interventions (19%). Most studies were conducted in the United States (59%) and had sample sizes ranging from 25 to 99 participants (58%). Approximately half of the studies enrolled community (i.e., not specifically military) participants (54%), and most were conducted in outpatient settings (78%). Studies typically enrolled participants with a mix of trauma types (51%). Among all 496 included RCTs, RoB was rated as high for 60 percent of studies, 27 percent were rated as having some concerns, and the remaining 14 percent were rated as low RoB. Among the 60 newly added RCTs, psychotherapy interventions were the most commonly employed (40%), followed by complementary and integrative health (10%). Approximately half of the studies were conducted in the United States (53%), and enrolled community participants (53%) and participants with a mix of trauma types (53%). Studies typically had sample sizes ranging from 25 to 99 participants (53%). Of the newly added RCTs, RoB was rated as high for 67 percent of studies, 17 percent were rated as having some concerns, and the remaining 17 percent were rated as low RoB. Conclusions. This report updates the previous AHRQ report to include 60 recently published RCTs, for a total of 496 studies. This update adds comprehensive data, standardized effect sizes for PTSD outcomes, and RoB assessment for the newly included RCTs. As with the previous AHRQ update, this report will serve as the updated evidence base for the PTSD-Repository, a comprehensive database of PTSD trials.