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Venlafaxine XR as Effective as Paroxetine in Reducing Panic Attacks - Even in Patients with Severe Panic Disorder: Presented at ADAA

By Cameron Johnston

TORONTO, ON -- March 31, 2003 -- Venlafaxine extended release (Effexor XR), a selective serotonin reuptake inhibitor, has proven to be as effective as paroxetine in short-term management of severe panic disorder.

The results of a recent clinical trial were presented here on March 29^th at the Annual Meeting of the Anxiety Disorders Association of America. The study was led by Mark H. Pollack, MD, director of the anxiety disorders clinic at Massachusetts General Hospital, in Boston. Dr. Pollack is also an associate professor of psychiatry at Harvard Medical School.

In the double-blind, placebo-controlled, parallel-group comparison study, 166 patients were treated with venlafaxine 37.5 mg/day for the first week, increasing to 75 mg/day for the remainder of the 12-week study. A second group of 168 patients received venlafaxine 37.5 mg/day for the first week, which was increased to 75 mg/day for the second week and to 150 mg/day for the remainder of the trial. These were compared with a group of 166 patients who received paroxetine in a starting dose of 10 mg/day, which was increased by 10 mg per week to a final dose of 40 mg/day, and a control group of 163 patients who received a placebo.

The patients at the start of the trial were considered severely disabled by panic disorder, according to the researchers. As part of the entry criteria, patients had to have experienced at least 4 panic attacks during a 2-week run-in period. In this case, the mean number of attacks experienced was approximately 11 regardless of which drug the patients were randomized to receive. Each patient had been experiencing panic attacks for an average of 3.5 years.

At the end of 12 weeks of treatment, the percentage of patients who were panic free, according to the PAAS measurement (Panic and Anticipatory Anxiety Scale) was 54.1% (venlafaxine 75 mg/day); 61.4% (venlafaxine 150 mg/day); 60.0% (paroxetine 40 mg/day); and 34.4% (placebo)

The subjects reported mean reductions in the number of panic attacks of 6.0 (venlafaxine 75 mg/day); 6.7 (venlafaxine 150 mg/day); 6.0 (paroxetine 40 mg/day); and 4.7 (placebo).

The mean reductions seen on the PAAS scores were 10.7, 14.2, 10.3 and 6.51, respectively.

Relief from the panic attacks was seen as early as week 4 for those using venlafaxine and as early as week 6 among those using paroxetine, Dr. Pollack reported.

Patients in each study group showed statistically significant improvements on all primary and secondary outcome measurements, including mean changes from baseline on the Panic Disorder Severity Score ranging from 9.3 to 9.6 in each treatment group. And, whereas at baseline approximately 90% of all subjects had CGI (Clinical Global Impression) scores ranging from 4 to 6, at the end of the study, approximately half of all subjects had scores of 1 or 2.

However, the rate of discontinuation was high in this study, with approximately 20% of patients in any study group ceasing treatment, mainly because of adverse events.

According to the investigators, the response and remission rates were comparable between the active treatment groups, and regardless of the medication they were taking, patients in each group experienced a more or less similar reduction in the number of panic attacks they experienced throughout the study.

They concluded that either venlafaxine or paroxetine will significantly reduce the number of panic attacks over the short term, even among patients who have relatively severe disorders, and who have had the condition for long periods of time.


[Study title: Venlafaxine XR And Paroxetine In The Short-Term Treatment Of Panic Disorder. Abstract P85.]

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