Comparative efficacy and acceptability of pharmacotherapeutic agents for anxiety disorders in children and adolescents: a mixed treatment comparison meta-analysis

Objective: to compare efficacy and acceptability of different pharmacotherapeutic agents for treating anxiety disorders in children and adolescents Methods: A recently conducted Cochrane Review on pharmacotherapy for anxiety disorders in children and adolescents was updated. A mixed treatment comparison meta-analysis using Bayesian Markov Chain Monte Carlo simulation was used to perform the indirect comparison. We calculated relative risk ratios (RR) with 95% credible interval (CrI) using placebo as the common comparator. Results: Data were combined from 16 clinical trials that randomized children to six different treatment strategies, including placebo. Fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine were more efficacious than placebo. Venlafaxine was significantly less efficacious than fluvoxamine (RR = 0.60; 95% CrI 0.35-0.95) and paroxetine (RR = 0.65; 95% CrI 0.44-0.93). Fluoxetine, fluvoxamine, paroxetine, and sertraline had higher acceptability profile than placebo. Venlafaxine was less tolerated than fluvoxamine (RR = 0.16; 95% CrI 0.01-0.64), paroxetine (RR = 0.21; 95% CrI 0.05-0.59), and sertraline (RR = 0.31; 95% CrI 0.08-0.83). Fluvoxamine had a higher rate of clinical response and acceptability compared to other treatments in the network, with probability of 47.5% and 50.6% of being the most efficacious and well-tolerated treatment, respectively. Conclusion: Clinically important differences exist between commonly prescribed pharmacotherapeutic agents for treating anxiety among children in terms of both efficacy and acceptability in favor of fluvoxamine. Fluvoxamine might be the best choice when starting treatment for anxiety disorders among children and adolescents because it has the most favorable balance between benefits and acceptability.