"Quetiapine Shows Promising Results for Treatment of Generalized Anxiety Disorder: Presented at ADAA"
By Fran Lowry
MIAMI, F.L. -- March 27, 2006 -- Two studies presented here at the 26[th annual conference of the Anxiety Disorders Association of America (ADAA) show promising results for use of the atypical antipsychotic, quetiapine, as both monotherapy and adjunctive therapy for treatment of generalized anxiety disorder (GAD).
One study was presented on March 25th by lead investigator Olga Brawman-Mintzer, associate professor, Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, United States.
Dr. Brawman-Mintzer and colleagues tested quetiapine in 38 non-depressed patients with GAD, who had a mean total Hamilton Rating Scale for Anxiety (HAM-A) score of 20 or greater. After a 1-week placebo run-in period, 19 subjects were randomized to 6 weeks of double-blind treatment with quetiapine 25-300 mg/day and 19 received placebo.
Quetiapine dosing was escalated to a maximum daily dose of 300 mg/day over a 2-week period based on tolerability and clinical response. Patients were assessed at baseline and weeks 1, 2, 4 and 6. The mean dose of quetiapine at the trial end was 125 mg/day.
Completion rates were 63.2% in the quetiapine group and 84.2% in the placebo group. Five patients in the quetiapine group and 2 in the placebo group discontinued treatment because of adverse events. One patient in each group was lost to follow-up and 1 patient on quetiapine withdrew consent, Dr. Brawman-Mintzer reported.
In addition to HAM-A total score, other outcome measures included change in HAM-A psychic anxiety and somatic subscales, Clinical Global Impressions-Improvement (CGI-I) and CGI-S scales, Hospital Anxiety and Depression (HAD) anxiety subscale scores, and Sheehan Disability Scale (SDS).
Quetiapine patients had greater improvements than placebo patients in all outcome measures at week 6, the researchers reported. This difference reached statistical significance at weeks 2 and 4 on the HAM-A total and HAM-A psychic anxiety scores.
Quetiapine was generally well tolerated and no serious adverse events occurred, Dr. Brawman-Mintzer said.
The second study on quetiapine in GAD presented at ADAA was led by Martin Katzman, MD, Director, START Clinic for Mood and Anxiety Disorders, University of Toronto, Toronto, Canada. His study showed that quetiapine was effective as an adjunctive treatment in patients with treatment-resistant or non-remitting GAD.
Patients with persistent GAD after at least 8 weeks of adequate conventional therapy with selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, and mirtazapine, received an initial dose of adjunctive quetiapine 25 mg/day which could be increased at the investigator's discretion.
By the study's end, more than 70% of the 32 patients had achieved remission, the researchers reported.
Adjunctive quetiapine also produced significant improvements in the quality of patients' sleep.
Although the study was open label, had a small sample, and no comparator arm, the investigators concluded that "the positive efficacy results are very promising for quetiapine adjunctive to conventional therapy in patients with GAD or those with treatment-resistant GAD.
[Presentation title: Quetiapine Monotherapy in Patients with Generalized Anxiety Disorder. Abstract 341. A Flexible-Dose, Open-Label Trial Evaluating the Efficacy and Safety of Quetiapine (Seroquel®) as Adjunctive Pharmacotherapy for the Treatment of Generalized Anxiety disorder (GAD). Abstract 291]
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