Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: Systematic review and network meta-Analysis of randomised controlled trials

Davide Papola*, Giovanni Ostuzzi, Federico Tedeschi, Chiara Gastaldon, Marianna Purgato, Cinzia Del Giovane, Alessandro Pompoli, Darin Pauley, Eirini Karyotaki, Marit Sijbrandij, Toshi A. Furukawa, Pim Cuijpers, Corrado Barbui

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

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 languageEnglish
Pages (from-to)507-519
Number of pages13
JournalBritish Journal of Psychiatry
Volume221
Issue number3
Early online date6 Oct 2021
DOIs
Publication statusPublished - 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

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