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【JAMA】较年长的焦虑症患者服用药物可能会有某
CHICAGO – Preliminary research suggests that use of the drug escitalopram provided some improvement in symptoms for older adults with generalized anxiety disorder, although the overall benefits were diminished because of nonadherence to the drug by some patients, according to a study in the January 21 issue of JAMA.
Generalized anxiety disorder (GAD), one of the most common psychiatric disorders in older adults, is defined by chronic, difficult-to-control worry and anxiety, with related symptoms such as muscle tension, sleep disturbance and fatigue. The prevalence of GAD is as high as 7.3 percent among community-dwelling older adults and even higher among primary care patients. Because the number of older adults in the U.S. is growing and there is a lack of effective treatment, GAD in older adults will become an increasing human and economic burden, according to background information in the article. Selective serotonin reuptake inhibitors (SSRIs) are effective for younger adults with GAD, but little data exist regarding the outcomes of their use by older adults.
Eric J. Lenze, M.D., of Washington University, St. Louis, and colleagues examined the effectiveness, safety, and tolerability of the SSRI escitalopram for the treatment of GAD in older adults. The study included 177 participants age 60 years or older with a diagnosis of GAD, who were randomized to receive either 10 to 20 mg/d of escitalopram (n = 85) or matching placebo (n = 92) for 12 weeks. Anxiety and other outcomes were measured using a number of assessment tools.
The researchers found that the cumulative incidence of response to treatment was higher in the escitalopram group than in the placebo group (69 percent vs. 51 percent). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning, activity limitations and impairments in role and social functioning.
In the intention-to-treat (ITT) analysis, which included those who began the trial but may have dropped out, the response was not different between groups. Of the participants who received escitalopram, 16 (18.5 percent) dropped out of the study before week 12; of the participants who received placebo, 17 (18.4 percent) dropped out before week 12.
Adverse effects of escitalopram were fatigue or sleepiness, sleep disturbance and urinary symptoms.
“The lack of efficacy of escitalopram in the ITT analysis is consistent with its overall modest efficacy, diminished further by nonadherence. Given that patients with anxiety disorders are often poorly adherent to pharmacotherapy, these negative results may more accurately portray the results of treatment in clinical settings,” the authors write.
“It is important for clinicians to emphasize to their anxious older patients the need for an adequate trial in which to observe any benefits, as well as the expectation and nature of adverse effects. Given the high human and economic burden of GAD, these data should provide impetus to detect and treat this common disorder. Further study is required to assess efficacy and safety over longer treatment durations.”
芝加哥 -- 据1月21日刊JAMA上的一则研究披露，初步的研究提示，患有泛焦虑症的年长患者在服用药物escitalopram（或译：艾司西酞普兰）后会有某些症状的改善，尽管这一总体上的裨益因为某些病人没有坚持服药而有所降低。
泛焦虑症（GAD）是年长患者中的最常见的精神科疾病之一。它的定义是：慢性、很难控制的担心和焦虑，并有诸如肌肉紧张、睡眠障碍和乏力等相关的症状。GAD的流行率在居住在社区的老年人中可以高达7.3%，但在初级关护的病人中甚至还会更高。根据文章的背景资料，由于美国老年人的数量不断增加，而且对GAD又缺乏有效的治疗，因此老年人中的GAD将成为一个不断增加的人力和经济负担。选择性的5-羟色胺再摄取抑制剂（SSRIs）对较年轻的GAD成人患者有效，但老年患者服用这些药物的结果如何却没有什么数据。
Washington University, St. Louis的Eric J. Lenze, M.D.及其同僚对老年GAD患者用SSRI escitalopram 进行治疗的效果、安全性和耐受性进行了检验。该项研究包括年龄在60岁或以上的177名诊断患有GAD的病人，这些人被随机指派服用12个星期的10-20毫克/每天的escitalopram (n = 85) 或是与其相匹配的安慰剂（n = 92）。研究人员还应用许多评估工具来估测患者的焦虑症及其它的临床结果。
研究人员发现，在escitalopram组中，受试者的对治疗的累积反应率比那些在安慰剂组的人要高（69% vs. 51%）。那些接受了escitalopram治疗的患者比在安慰剂组的患者在焦虑症状、角色功能、活动限制及角色损害和社会功能损害方面都呈现出更大的改善。
在意向处理（ITT）分析中（该分析还纳入那些原先参加了试验但可能在后来又离去的人），这两组人之间则没有差别。在接受escitalopram的参与者中，有16人（占18.5%）在第12周之前就退出了该研究；在安慰剂组的参与者中，有17人（占18.4%）在第12周之前退出了该研究。
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作者:admin@医学,生命科学 2011-03-25 05:11
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