Pharmacological treatments for generalised anxiety disorder

The network meta-analysis by April Slee and colleagues1Slee A Nazareth I Bondaronek P Liu Y Cheng Z Freemantle N Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis.Lancet. 2019; 393: 768-777Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar studied the effect of 22 drugs for the treatment of generalised anxiety disorder and showed that several drugs were effective and well tolerated. We, however, consider that the inclusion of 16 randomised controlled trials from China in this network meta-analysis is highly questionable. Only one2Wu W Gang W Ball S G et al.Duloxetine versus placebo in the treatment of patients with generalized anxiety disorder in China.Chin Med J. 2011; 124: 3260-3268PubMed Google Scholar of these trials was registered on a clinical trial registry platform and provided evidence of ethical approval. Ten trials were published by Chinese predatory journals; these journals tend to accept articles with no or inappropriate peer review, meaning that any study can be published as long as the publication fee is paid. Therefore, the quality of studies in these journals cannot be guaranteed. Many studies published in such journals have been found to be fake research.3Cyranoski D Strong medicine for China's journals.Nature. 2010; 467: 261Crossref PubMed Scopus (11) Google Scholar Additionally, only three of the 16 trials reported that articles used correct randomisation methods and three articles used inappropriate study methods. For example, the research published by Huang and colleagues4Huang Y Zhu J Jiang X et al.A comparative study of mirtazapine and alprazolam in the treatment of generalized anxiety.Chin J Behavioral Med Sci. 2005; 14: 919Google Scholar was randomised according to the order of outpatient visits to receive different treatments. The remaining ten articles did not give enough details to establish whether the studies were truly randomised. A study by Wu and colleagues5Wu T Li Y Bian Z et al.Randomized trials published in some Chinese journals: how many are randomized?.Trials. 2009; 10: 46Crossref PubMed Scopus (184) Google Scholar showed that only 7% of randomised controlled trials published in Chinese medical journals are truly randomised. Therefore, we have serious doubts on the validity and reliability of the data from at least 15 trials published in China. Systematic reviews are cornerstones of clinical practice guidelines and their conclusions should be reliable and accurate. To avoid misleading practitioners, we recommend that reviewers should do their best to verify the studies they included, and if necessary, to contact the authors to assess the quality of studies. We declare no competing interests. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysisTo our knowledge, this is the largest contemporary review of pharmacological agents for the treatment of generalised anxiety disorder by use of network analysis. There are several effective treatment choices for generalised anxiety disorder across classes of medication. The failure of initial pharmacological therapy might not be a reason to abandon a pharmacological treatment strategy. Full-Text PDF Pharmacological treatments for generalised anxiety disorderIn their systematic review and network meta-analysis, April Slee and colleagues1 asserted that several pharmacological treatments were effective for generalised anxiety disorder. We would like to highlight several limitations of their analysis. Full-Text PDF Pharmacological treatments for generalised anxiety disorder – Authors' replyKlaus Munkholm and colleagues raise several interesting issues; however, we disagree that our results1 have a very low level of certainty. Our protocol was published a priori2 and we went to extensive and exhaustive lengths to identify many completed trials, providing the most comprehensive summary of evidence to date using robust methods. More than half of the trials in our analysis were done for regulatory purposes and were held to high standards of study conduct. A 2018 network meta-analysis for depression3 also found high risk of bias according to the scale recommended by the Cochrane Handbook for Systematic Reviews of Interventions;4 in fact, none of those studies achieved a low risk of bias across all categories. Full-Text PDF