A controlled trial of quetiapine XR coadministration treatment of SSRI-resistant panic disorder

Andrew W Goddard, Waqar Mahmud, Carla Medlock, Yong-Wook Shin, Anantha Shekhar, Andrew W Goddard, Waqar Mahmud, Carla Medlock, Yong-Wook Shin, Anantha Shekhar

Abstract

Background: Open-label quetiapine coadministration with SSRI therapy, in a diagnostically mixed sample of comorbid anxiety patients, offered additional anxiolytic benefit. Therefore, we designed the following controlled trial to confirm these findings in a comorbid, SSRI-resistant, panic disorder (PD) patient sample.

Methods: This was a single-site, double-blind, placebo-controlled (PLAC), randomized, parallel group (2 groups), 8-week, quetiapine extended release (XR) coadministration trial. SSRI resistance was determined either historically or prospectively. Patients were randomized if they remained moderately ill (CGI-S score ≥ 4). Change in the PDSS scale total score was the primary efficacy outcome measure. Responders were identified as those with a ≥50 % decrease from their baseline PDSS score. In the early weeks of therapy, XR was flexibly and gradually titrated from 50 to 400 mg/day.

Results: 43 patients were screened in total, and 26 of these were randomized and evaluable. 21 patients (78 % of the randomized group) completed the trial (10 XR; 11 PLAC). The endpoint quetiapine XR mean daily dose ± SD was 150 ± 106 mg. While, in the sample as a whole, there was improvement in PDSS scores across the 8-week trial (ANOVA main effect of time, F = 10.9, df 8,192, p < 0.0001), the treatment × time interaction effect was not statistically significant (F = 0.8, df 8,192, p = 0.61). There was no between-group difference in responder frequency at endpoint.

Conclusions: This proof-of-concept RCT did not support the efficacy of this treatment strategy for SSRI-resistant PD. Quetiapine XR was generally well-tolerated. Important limitations were the small sample size, and the relatively low average dose of quetiapine XR used. ClinicalTrials.gov ID#: NCT00619892.

Keywords: Atypical neuroleptics; Augmentation treatment; Panic disorder; Quetiapine XR.

Figures

Fig. 1
Fig. 1
Patient flow summary (randomization: XR n = 14, PLAC n = 13)
Fig. 2
Fig. 2
Efficacy data. Mean ± SD PDSS total scores (0–28) (ITT data set; n = 26)

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Source: PubMed

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