Impiego della quetiapina nel trattamento dei disturbi d’ansia

anxietyNegli ultimi anni una serie di lavori hanno messo in evidenza l’efficacia della quetiapina nel trattamento del disturbo d’ansia generalizzato (GAD), impiegata a dosaggi più bassi dell’utilizzo nei disturbi dell’umore (da 50 a 300mg/die) (1,2,,3). In questa review vengono passati in rassegna tutti i lavori presenti nel database Medline fino al maggio 2014 relativi all’utilizzo di quetiapina nel GAD e nel trattamento dell’ansia in generale, sia in monoterapia che in associazione ad altri farmaci.

In questa pubblicazione gli autori mettono in evidenza 9 studi, di questi tre valutavano l’uso della quetiapina RP nel trattamento del GAD in acuto e in monoterapia, uno studio valutava l’utilizzo della quetiapina RP in monoterapia di mantenimento, e cinque studi valutavano la quetiapina (due nella formulazione RP e tre a rilascio immediato) come add-on per il trattamento del GAD in acuto. In tutti i trial in monoterapia la quetiapina mostrava una buona efficacia e tollerabilità sia nel trattamento acuto che di mantenimento del GAD. In tre dei cinque studi dove la quetiapina era utilizzata in add-on, si dimostravano miglioramenti statisticamente significativi ai punteggi della Hamilton Anxiety Rating Scale o alla Clinical Global Impressions-Severity of Illness Scale dopo l’aggiunta della quetiapina. Quindi gli autori concludono che la quetiapina potrebbe essere una valida opzione terapeutica nei pazienti che non mostrano risposte soddisfacenti agli usuali trattamenti con antidepressivi.

Pharmacotherapy. 2015 Feb;35(2):175-88.

A literature review of quetiapine for generalized anxiety disorder.

To evaluate the efficacy and tolerability of quetiapine for the treatment of generalized anxiety disorder (GAD), a literature search of the Medline database was conducted from inception to May 2014. The search was not restricted by language. Keywords used in the search were quetiapine and generalized anxiety disorder or anxiety. All studies assessing the use of quetiapine as monotherapy or adjunct therapy for the primary management of GAD in adults 18-65 years of age were included in this review. The nine studies included in this review were three studies evaluating the use of quetiapine extended release (XR) as monotherapy for acute GAD treatment, one study evaluating quetiapine XR monotherapy for maintenance treatment of GAD, and five studies evaluating quetiapine (2 XR, 3 immediate release) as adjunct therapy for acute GAD treatment. Quetiapine displayed both efficacy and tolerability in all monotherapy trials evaluating its use for acute and long-term treatment of GAD. Despite some limitations to and heterogeneity among the five adjunct therapy studies, three studies showed that quetiapine resulted in statistically significant changes in the Hamilton Anxiety Rating Scale or Clinical Global Impressions-Severity of Illness Scale scores. Although future studies of longer duration with broader inclusion criteria are needed to further evaluate the benefits and risks of quetiapine for GAD, in patients failing to respond to conventional antidepressant therapy, quetiapine may be a potential treatment option. With appropriate monitoring and management of adverse effects, the potential benefits of quetiapine in patients with treatment-refractory GAD may outweigh the risks associated with its use.

Kreys TJ, Phan SV.

Author information:  California Northstate University, College of Pharmacy, Elk Grove, California

1) Int J Geriatr Psychiatry. 2013 Jun;28(6):615-25. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Mezhebovsky I, Mägi K, She F, Datto C, Eriksson H.

2) Int Clin Psychopharmacol. 2014 Sep;29(5):252-62. Efficacy of once-daily extended release quetiapine fumarate in patients with different levels of severity of generalized anxiety disorder. Montgomery SA, Locklear JC, Svedsäter H, Eriksson H.

3) Int Clin Psychopharmacol. 2012 Jan;27(1):40-54. Efficacy and tolerability of extended release quetiapine fumarate monotherapy in the acute treatment of generalized anxiety disorder: a randomized, placebo controlled and active-controlled study. Merideth C, Cutler AJ, She F, Eriksson H

Comments are Disabled