Abstract
Background Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. Aims To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-Analysis. Method We conducted a systematic review and network meta-Analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-Analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). Results We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. =-0.67, 95% CI-0.95 to-0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI-0.94 to 1.56; CINeMA: moderate) and short-Term psychodynamic therapy (for efficacy: s.m.d. =-0.61, 95% CI-1.15 to-0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. Conclusions CBT and short-Term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-Analysis should inform clinicians and guidelines.
Original language | English |
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Pages (from-to) | 507-519 |
Number of pages | 13 |
Journal | British Journal of Psychiatry |
Volume | 221 |
Issue number | 3 |
Early online date | 6 Oct 2021 |
DOIs | |
Publication status | Published - Sept 2022 |
Bibliographical note
Funding Information:T.A.F. reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work. E.K. and P.C. are members of BJPsych editorial board and did not take part in the review or decision-making process of this paper.
Publisher Copyright:
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
Funding
T.A.F. reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work. E.K. and P.C. are members of BJPsych editorial board and did not take part in the review or decision-making process of this paper.
Keywords
- Network meta-Analysis
- Outcomes
- Panic disorder
- Psychotherapy
- Systematic review