Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness
IntroductionGeneralized Anxiety Disorder (GAD) is a mental health condition with a recent increase in prevalence. GAD is often underdiagnosed, leading to negative consequences for individuals, healthcare systems, and society. The economic burden and impaired quality of life associated with GAD under...
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Frontiers Media S.A.
2025-02-01
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| author | Narcis Cardoner Narcis Cardoner Narcis Cardoner Narcis Cardoner Luis Gutiérrez-Rojas Luis Gutiérrez-Rojas Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Guillermo Lahera Guillermo Lahera Guillermo Lahera Guillermo Lahera Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega María Pérez-Páramo |
| author_facet | Narcis Cardoner Narcis Cardoner Narcis Cardoner Narcis Cardoner Luis Gutiérrez-Rojas Luis Gutiérrez-Rojas Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Guillermo Lahera Guillermo Lahera Guillermo Lahera Guillermo Lahera Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega María Pérez-Páramo |
| author_sort | Narcis Cardoner |
| collection | DOAJ |
| description | IntroductionGeneralized Anxiety Disorder (GAD) is a mental health condition with a recent increase in prevalence. GAD is often underdiagnosed, leading to negative consequences for individuals, healthcare systems, and society. The economic burden and impaired quality of life associated with GAD underscores the need for effective treatment. Pregabalin has shown promise in reducing anxiety symptoms; however, further research is needed to evaluate its efficacy and compare it with other treatment options. This study aimed to assess the efficacy, safety, and optimal pregabalin dosage for the treatment of GAD.MethodsThis meta-analysis followed PRISMA guidelines. Pregabalin-treated patients comprised the intervention group, whereas the comparator group received benzodiazepines, SSRIs, SNRIs, or placebo. Efficacy and safety were evaluated using various scales and adverse events (AEs). Randomized clinical trials were included in the study. Four major databases were used for this study. Outcome measures included the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Improvement Scale (CGI-I), discontinuation rates, costs, and quality-adjusted life-years (QALYs). Meta-analyses were conducted using Review Manager 5.4 software, employing odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed based on follow-up and dosage.ResultsFourteen studies involving 4,822 patients were analyzed. Pregabalin demonstrated superior efficacy in reducing HAM-A global scores at 2 weeks (MD −1.23, 95% CI −1.79 to −0.66), 4 weeks (MD −1.12, 95% CI −1.60 to −0.63), 8 weeks (MD −2.50, 95% CI −4.21 to −0.79), 12 weeks (MD 0.99, 95% CI 0.35–1.63), and 6 months to 1 year (MD −3.31, 95% CI −4.30 to −2.31). Pregabalin also showed a higher response rate to HAM-A (OR 1.51, 95% CI 1.31 1.75). CGI-I scores favored pregabalin (MD −0.25, 95% CI −0.38 to −0.12), with a higher response rate (OR 1.33, 95% CI 1.15–1.55). The discontinuation rates were lower with pregabalin (OR 0.80, 95% CI 0.70, 0.91). Adverse events favored pregabalin over SSRIs/SNRIs and benzodiazepines at different doses. Pregabalin was associated with higher cost-effectiveness (MD 0.02, 95% CI 0.01, 0.03).ConclusionPregabalin is an effective and well-tolerated treatment for generalized anxiety disorder, showing superior efficacy and safety compared with first-line medications.Systematic Review RegistrationPROSPERO CRD42024556152. |
| format | Article |
| id | doaj-art-5b71e71f0b6b472d83768d1207dafd96 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-5b71e71f0b6b472d83768d1207dafd962025-02-07T09:04:56ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-02-011610.3389/fphar.2025.14837701483770Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectivenessNarcis Cardoner0Narcis Cardoner1Narcis Cardoner2Narcis Cardoner3Luis Gutiérrez-Rojas4Luis Gutiérrez-Rojas5Pilar Saiz6Pilar Saiz7Pilar Saiz8Pilar Saiz9Pilar Saiz10Guillermo Lahera11Guillermo Lahera12Guillermo Lahera13Guillermo Lahera14Miguel Ángel Álvarez-Mon15Miguel Ángel Álvarez-Mon16Miguel Ángel Álvarez-Mon17Miguel Ángel Álvarez-Mon18Pino Alonso Ortega19Pino Alonso Ortega20Pino Alonso Ortega21Pino Alonso Ortega22María Pérez-Páramo23Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainInstitut d’Investigació Biomèdica Sant Pau IIB SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainCentro de Investigación Biomédica En Red en Salud Mental CIBERSAM, Instituto de Salud Carlos III, Madrid, SpainDepartment of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, SpainDepartment of Psychiatry, University of Granada, Granada, SpainDepartment of Psychiatry, University of Oviedo, Oviedo, SpainCIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, SpainInstituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain0Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain1Servicio de Salud del Principado de Asturias (SESPA) Oviedo, Oviedo, SpainCIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain2Department of Psychiatry, Universidad de Alcalá, Madrid, Spain3Príncipe de Asturias University Hospital, Oviedo, Spain4Instituto de Investigación Sanitaria Ramón y Cajal (IRyCIS), Madrid, SpainCIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain5Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain6Department of Medicine and Medical Specialties, University of Alcala, Alcala de Henares, Spain7Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, SpainCIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain8Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain9Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain0Department of Clinical Sciences, University of Barcelona, Barcelona, Spain1Medical Department, Viatris, Madrid, SpainIntroductionGeneralized Anxiety Disorder (GAD) is a mental health condition with a recent increase in prevalence. GAD is often underdiagnosed, leading to negative consequences for individuals, healthcare systems, and society. The economic burden and impaired quality of life associated with GAD underscores the need for effective treatment. Pregabalin has shown promise in reducing anxiety symptoms; however, further research is needed to evaluate its efficacy and compare it with other treatment options. This study aimed to assess the efficacy, safety, and optimal pregabalin dosage for the treatment of GAD.MethodsThis meta-analysis followed PRISMA guidelines. Pregabalin-treated patients comprised the intervention group, whereas the comparator group received benzodiazepines, SSRIs, SNRIs, or placebo. Efficacy and safety were evaluated using various scales and adverse events (AEs). Randomized clinical trials were included in the study. Four major databases were used for this study. Outcome measures included the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Improvement Scale (CGI-I), discontinuation rates, costs, and quality-adjusted life-years (QALYs). Meta-analyses were conducted using Review Manager 5.4 software, employing odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed based on follow-up and dosage.ResultsFourteen studies involving 4,822 patients were analyzed. Pregabalin demonstrated superior efficacy in reducing HAM-A global scores at 2 weeks (MD −1.23, 95% CI −1.79 to −0.66), 4 weeks (MD −1.12, 95% CI −1.60 to −0.63), 8 weeks (MD −2.50, 95% CI −4.21 to −0.79), 12 weeks (MD 0.99, 95% CI 0.35–1.63), and 6 months to 1 year (MD −3.31, 95% CI −4.30 to −2.31). Pregabalin also showed a higher response rate to HAM-A (OR 1.51, 95% CI 1.31 1.75). CGI-I scores favored pregabalin (MD −0.25, 95% CI −0.38 to −0.12), with a higher response rate (OR 1.33, 95% CI 1.15–1.55). The discontinuation rates were lower with pregabalin (OR 0.80, 95% CI 0.70, 0.91). Adverse events favored pregabalin over SSRIs/SNRIs and benzodiazepines at different doses. Pregabalin was associated with higher cost-effectiveness (MD 0.02, 95% CI 0.01, 0.03).ConclusionPregabalin is an effective and well-tolerated treatment for generalized anxiety disorder, showing superior efficacy and safety compared with first-line medications.Systematic Review RegistrationPROSPERO CRD42024556152.https://www.frontiersin.org/articles/10.3389/fphar.2025.1483770/fullpregabalinbenzodiazepinesSSRIsSNRIs generalized anxiety disorderefficacysafety |
| spellingShingle | Narcis Cardoner Narcis Cardoner Narcis Cardoner Narcis Cardoner Luis Gutiérrez-Rojas Luis Gutiérrez-Rojas Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Pilar Saiz Guillermo Lahera Guillermo Lahera Guillermo Lahera Guillermo Lahera Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Miguel Ángel Álvarez-Mon Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega Pino Alonso Ortega María Pérez-Páramo Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness Frontiers in Pharmacology pregabalin benzodiazepines SSRIs SNRIs generalized anxiety disorder efficacy safety |
| title | Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness |
| title_full | Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness |
| title_fullStr | Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness |
| title_full_unstemmed | Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness |
| title_short | Does pregabalin offer potential as a first-line therapy for generalized anxiety disorder? A meta-analysis of efficacy, safety, and cost-effectiveness |
| title_sort | does pregabalin offer potential as a first line therapy for generalized anxiety disorder a meta analysis of efficacy safety and cost effectiveness |
| topic | pregabalin benzodiazepines SSRIs SNRIs generalized anxiety disorder efficacy safety |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1483770/full |
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