Sustavni pregled i meta-analiza kliničkih pokusa metodama komplementarne i alternativne medicine u liječenju generaliziranoga anksioznoga poremećaja

Abstract

Objective: To evaluate efficacy/safety of complementary and alternative medicine (CAM) methods for generalized anxiety disorder (GAD) based on randomized controlled trials (RCT) in adults. Data sources: Six electronic databases (”generalized anxiety (disorder)” AND “randomized trial”) and reference lists of identified publications were searched to March 2017. Study selection: Eligibility: full-text publications (English, German language); CAM vs. conventional treatment, placebo/sham or no treatment; GAD diagnosed according to standard criteria; a validated scale for disease severity. Of the 6693 screened records, 32 were included (18 on biologically-based therapies, exclusively herbal preparations; 8 on manipulative and body-based therapies; 3 on alternative medical systems and 3 on mind-body therapies). Data extraction: Cochrane Collaboration methodology for study quality assessment and data extraction. Results: Direct comparisons of Kava Kava extracts to placebo (4 quality trials, N=233) were highly heterogeneous. Combination of direct and arm-level comparisons reduced heterogeneity suggesting a modest Kava effect end-of-treatment Hamilton Anxiety scale score difference: -3.24 (95%CI -6.65, 0.17; P=0.059), Kava 4 arms, N=139; placebo 5 arms, N=359. Lavender extract (1 quality trial, 10 weeks, N=523) and combination of extracts of C. oxycantha, E. californica and magnesium (1 quality trial, 12 weeks, N=264) were superior to placebo and balneotherapy was superior to paroxetine (one quality trial, 8 weeks, N=237) indicating efficacy. All other trials were small or biased or lacked assay sensitivity. Safety reporting was poor. Conclusions: Evidence about efficacy/safety of CAM methods in GAD is limited: small (imprecision), commonly biased trials (performance, detection, attrition) result in high uncertainty about the estimates. Evidence summarized in this systematic review indicate efficacy and safety of two herbal preparations and one specific balneotherapy protocol, therefore we consider them suitable for assessment in quality trials as a part of integrative treatment strategies for GAD