AUTHOR=Yan Jin-Zhu , Liu Jia-Ling , Li Xiao-Zheng , Zhang Zhi-Xin , Liu Run-Ben , Zhang Chao , Gong Qin-Qin 

TITLE=Effectiveness, Acceptability and Safety of Pharmaceutical Management for Combat-Related PTSD in Adults Based on Systematic Review of Twenty-Two Randomized Controlled Trials

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.805354

DOI=10.3389/fphar.2021.805354

ISSN=1663-9812

ABSTRACT=Objective: This study assessed the efficacy, acceptability, and safety of pharmaceutical management for combat-related post-traumatic stress disorder (PTSD) to provide clinical decision-making basis for clinicians.
Method: A comprehensive search was conducted using Ovid MEDLINE, Ovid EMBASE and Cochrane Library 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 placebo in acceptability, overall active comparators did not significant decrease all-cause discontinuance rates (RR=0.97, 95%CI (0.78,1.20)), but significant increased discontinued due to AEs (RR=2.42, 95%CI (1.41,4.13)). Nevertheless, overall active comparators were not statistically significant difference for overall AEs, including somnolence, sedation, dizziness, paresthesia, anxiety and blurred vision, generalized anxiety disorder and sleep disturbance. All funnel plots were symmetrical and no publication bias was found.
Conclusion: Active drugs, in especial amitriptyline, imipramine and quetiapine, had a positive effect on the improvement of combat-related PTSD symptoms. Despite there was no significant increase in AEs of the active drugs, the fact that the discontinuation rates of these drugs, including risperidone, imipramine and topiramate, were increased still deserves attention. Furthermore, active drugs had been shown to be effective across ethnic groups and battlefields, active drug regiments were more appropriate for treating people with symptoms of extreme severe PTSD (≥80) or at least 8 weeks old. In addition, the current evidence was all 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.