TY - JOUR
T1 - Effectiveness and safety of long-term benzodiazepine use in anxiety disorders
T2 - A systematic review and meta-analysis
AU - Shinfuku, Masaki
AU - Kishimoto, Taishiro
AU - Uchida, Hiroyuki
AU - Suzuki, Takefumi
AU - Mimura, Masaru
AU - Kikuchi, Toshiaki
N1 - Funding Information:
Dr. Shinfuku has received manuscript fees from Dainippon-Sumitomo. Dr. Kishimoto has received grants from Otsuka, speaker's honoraria from Abbvie, Banyu, Eli Lilly, Dainippon-Sumitomo, Janssen, Meiji-Seika Pharmaceutical, Novartis, Otsuka and Pfizer; and advisory payments from Dainippon-Sumitomo Pharma, Janssen and Otsuka, Taisho within three years. Dr. Uchida has received grants from Eisai, Otsuka Pharmaceutical, Dainippon-Sumitomo Pharma, Mochida Pharmaceutical, Meiji-Seika Pharmaceutical, and Novartis; speaker's honoraria from Otsuka Pharmaceutical, Eli Lilly, Shionogi, Pfizer, Yoshitomi Yakuhin, Dainippon-Sumitomo Pharma, Meiji-Seika Pharma, MSD, and Janssen Pharmaceutical; and advisory panel payments from Dainippon-Sumitomo Pharma within the past three years. Dr. Suzuki has received manuscript or speaker's fees from Astellas, Dainippon-Sumitomo Pharma, Eli Lilly, Elsevier Japan, Janssen Pharmaceuticals, Meiji-Seika Pharma, Novartis, Otsuka Pharmaceutical, Wiley Japan, and Yoshitomi Yakuhin, and research grants from Eisai, Mochida Pharmaceutical, and Meiji-Seika Pharma. Dr. Mimura has received grants from Otsuka, Mochida, Novartis, Eisai, Lilly, Fuji Film, Chugai, Jansen, Yoshitomi, and Meiji and personal fees from Otsuka, Avvi, Mochida, Novartis, Eisai, Lilly, Pfizer, Chugai, Jansen, Takeda, Ono, Yoshitomi, Meiji, Cracie, Astellas, Daiichi Sankyo, Shionogi, Asahi Kasei and MSD. Dr. Kikuchi has received speaker's honoraria from Dainippon-Sumitomo, Eli Lilly, MSD, Takeda Pharmaceutical, Yoshitomi Yakuhin and Pfizer.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Long-term benzodiazepines (BZDs) use is not endorsed in the treatment guidelines for anxiety disorders, but is prevalent in the real-world clinical settings. A systematic literature review was performed by using PubMed (last search: May 2019) to identify randomized controlled trials (RCTs) or maintenance studies following RCT that examined the effectiveness of BZDs in patients with anxiety disorders for a duration of 13 weeks or more. Meta-analyses were then conducted regarding changes in the Hamilton Anxiety Rating Scale (HAM-A) scores from baseline through endpoint, all-cause discontinuation, side effects, and the numbers of panic attacks at endpoint. Eight studies were identified (N = 1228). There were no significant differences in all outcomes between BZDs and antidepressants after the initial 8-week treatment. While no significant difference was noted in the HAM-A score changes between BZDs and placebo, BZDs resulted in a lower discontinuation rate and more frequent constipation and dry mouth than placebo. Our study indicates that for those who respond to an initial 8-week treatment, continuing BZDs is equivalent to antidepressants in efficacy and safety. However, the limited number of studies warranted further investigations of the long-term effectiveness and safety of BZDs.
AB - Long-term benzodiazepines (BZDs) use is not endorsed in the treatment guidelines for anxiety disorders, but is prevalent in the real-world clinical settings. A systematic literature review was performed by using PubMed (last search: May 2019) to identify randomized controlled trials (RCTs) or maintenance studies following RCT that examined the effectiveness of BZDs in patients with anxiety disorders for a duration of 13 weeks or more. Meta-analyses were then conducted regarding changes in the Hamilton Anxiety Rating Scale (HAM-A) scores from baseline through endpoint, all-cause discontinuation, side effects, and the numbers of panic attacks at endpoint. Eight studies were identified (N = 1228). There were no significant differences in all outcomes between BZDs and antidepressants after the initial 8-week treatment. While no significant difference was noted in the HAM-A score changes between BZDs and placebo, BZDs resulted in a lower discontinuation rate and more frequent constipation and dry mouth than placebo. Our study indicates that for those who respond to an initial 8-week treatment, continuing BZDs is equivalent to antidepressants in efficacy and safety. However, the limited number of studies warranted further investigations of the long-term effectiveness and safety of BZDs.
KW - anxiety disorders
KW - benzodiazepines
KW - long-term effects
KW - meta-analysis
KW - side effects
UR - http://www.scopus.com/inward/record.url?scp=85071057925&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071057925&partnerID=8YFLogxK
U2 - 10.1097/YIC.0000000000000276
DO - 10.1097/YIC.0000000000000276
M3 - Review article
C2 - 31274696
AN - SCOPUS:85071057925
SN - 0268-1315
VL - 34
SP - 211
EP - 221
JO - International clinical psychopharmacology
JF - International clinical psychopharmacology
IS - 5
ER -