Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials

Figures & data

Figure 1 The flow diagram of the study.

Abbreviation: EU-CTR, EU Clinical Trials Register.

Table 1 Basic characteristics of controlled trials of quetiapine vs placebo in generalized anxiety disorder

Study (author and year)	Number of randomized patients	Age of subjects (years)	Study duration (weeks)	Drug/dose	Diagnostic criteria	Response criteria	Remission criteria	Outcome measures	Study site/ethnic
Bandelow et al,^Citation35 2010	873	18–65	11–14	Quetiapine/50, 150 mg/day	DSM IV-TR	≥50% reduction in HAM-A	HAM-A ≤7	HAM-A, CGI-S, CGI-I, MADRS, PSQI	Europe, Argentina, Canada, Mexico, Africa/Caucasian =94%
Khan et al,^Citation36 2011	951	18–65	11–14	Quetiapine/50, 150, 300 mg/day	DSM IV-TR	≥50% reduction in HAM-A	HAM-A ≤7	HAM-A, CGI-S, CGI-I, MADRS, PSQI, Q-LES-Q	USA/Caucasian =80%–84% (for each treatment group)
Merideth et al,^Citation4320l2	854	18–65	10–14	Quetiapine/150, 300 mg/day	DSM IV-TR	≥50% reduction in HAM-A	HAM-A ≤7	HAM-A, CGI-S, CGI-I, MADRS, PSQI, Q-LES-Q	USA/Caucasian =79%–82%, Black = 10%–15% (for each treatment group)

Abbreviations: CGI-I, Clinical Global Impression-Improvement; CGI-S, Clinical Global Impression-Severity; HAM-A, Hamilton Anxiety Rating Scale; MADRS, Montgomery-Åsberg Depression Rating Scale; PSQI, Pittsburgh Sleep Quality Index; Q-LES-Q, Quality of Life Enjoyment and Satisfaction Questionnaire; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders, Fourth edition text revision.

Table 2 Summary of risk of bias in clinically controlled trials of quetiapine vs placebo in generalized anxiety disorder

Study	Issue of bias
	1	2	3	4	5	6	7
Bandelow et al^Citation35	L	L	L	L	L	L	L
Khan et al^Citation36	L	L	L	U	L	U	L
Merideth et al^Citation43	L	L	L	U	L	U	L

Notes: 1= adequate sequence generation of randomization (selection bias); 2= allocation concealment (selection bias); 3= blinding of participants and personnel (performance bias); 4= blinding of outcome assessment (detection bias); 5= incomplete outcome data (attrition bias); 6= selective reporting (reporting bias); 7= other sources of bias (other bias); U= unclear; and L= low risk of bias.

Figure 2 The forest plot of comparison of the mean changes from the baseline of the HAM-A scores (95% confidence interval) of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release.

Figure 3 The forest plot of comparison of relative risks (95% confidence interval) for the clinical response rates of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.

Figure 4 The forest plot of comparison of relative risks (95% confidence interval) for the clinical remission rates of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.

Figure 5 The forest plot of comparison of the mean changes from the baseline of the CGI-S scores (95% confidence interval) of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; CGI-S, Clinical Global Impression-Severity; XR, extended-release.

Figure 6 The forest plot of comparison of relative risks (95% confidence interval) for the clinical improvement rate (CGI-I =1, 2) of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; CGI-I, Clinical Global Impression-Improvement; XR, extended-release.

Figure 7 The forest plot of comparison of the mean changes from the baseline of the HAM-A scores (95% confidence interval) of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; HAM-A, Hamilton Anxiety Rating Scale; SSRIs, selective serotonin reuptake inhibitors.

Figure 8 The forest plot of comparison of relative risks (95% confidence interval) for the clinical response rates of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 9 The forest plot of comparison of relative risks (95% confidence interval) for the clinical remission rates of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 10 The forest plot of comparison of the mean changes from the baseline of the CGI-S scores (95% confidence interval) of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; CGI-S, Clinical Global Impression-Severity; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 11 The forest plot of comparison of relative risks (95% confidence interval) for the clinical improvement rate (CGI-I =1, 2) of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; CGI-I, Clinical Global Impression-Improvement; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 12 The forest plot of comparison of the mean changes from the baseline of the PSQI scores (95% confidence interval) of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; PSQI, Pittsburgh Sleep Quality Index.

Figure 13 The forest plot of comparison of the mean changes from the baseline of the PSQI scores (95% confidence interval) of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; SD, standard deviation; XR, extended-release; PSQI, Pittsburgh Sleep Quality Index; SSRIs, selective serotonin reuptake inhibitors.

Figure 14 The forest plot of comparison of the mean changes from the baseline of the MADRS scores (95% confidence interval) of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; MADRS, Montgomery–Åsberg Depression Rating Scale; SD, standard deviation; XR, extended-release.

Figure 15 The forest plot of comparison of the mean changes from the baseline of the MADRS scores (95% confidence interval) of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; IV, inverse variance; df, degrees of freedom; GAD, generalized anxiety disorder; MADRS, Montgomery–Åsberg Depression Rating Scale; SD, standard deviation; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 16 The forest plot of comparison of relative risks (95% confidence interval) for the overall discontinuation rate of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.

Figure 17 The forest plot of comparison of relative risks (95% confidence interval) for the overall discontinuation rate of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release; SSRIs, selective serotonin reuptake inhibitors.

Figure 18 The forest plot of comparison of relative risks (95% confidence interval) for the discontinuation rate due to adverse events of quetiapine vs placebo in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; XR, extended-release.

Figure 19 The forest plot of comparison of relative risks (95% confidence interval) for the discontinuation rate due to adverse events of quetiapine vs SSRIs in GAD.

Abbreviations: CI, confidence interval; df, degrees of freedom; GAD, generalized anxiety disorder; M–H, Mantel–Haenszel; SSRIs, selective serotonin reuptake inhibitors.

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