Sertraline treatment of panic disorder: Response in patients at risk for poor outcome

Background: More than one third of panic disorder patients have a chronic a nd/or recurrent form of the disorder, accounting fur much of the individual and societal cost associated with the illness. Six clinical variables have been most consistently identified as high-risk predictors of Door outcome: (1) panic severity, (2) presence of agoraphobia, (3) comorbid depression, (4) comorbid personality disorder, (5) duration of illness, and (6) female sex. No published research has systematically examined the differential ant ipanic efficacy of selective serotonin reuptake inhibitors in patients at h igh risk for poor outcome. Method: Data were pooled (N = 664) from 4 double-blind, placebo-controlled studies of the efficacy of sertra-line: for the treatment of DSM-III-R pani c disorder. Two of the studies were 12-week; fixed-dose studies with starti ng daily doses of sertraline, 50 mg, and 2 were 10-week flexible-dose studi es with starting daily doses of sertra-line, 3,5 mg. All other study design features were the same, except for the exclusion of women of childbearing potential in the 2 fixed-dose studies. Exclusion of patients with marked pe rsonality disorders and depression meant that only 3 of the poor-outcome va riables could be evaluated. Results: Clinical improvement was similar for patients treated with sertral ine whether or not they carried an agoraphobia diagnosis, had a duration of illness > 2 years, or wen female. Patients with high baseline panic severi ty had significantly (p = .01) less improvement on the endpoint Clinical Gl obal Impressions-Improvement (CGI-I) scale than patients with moderate seve rity, although the Clinical Global Impressions-Severity of Illness scale ch ange score was higher in the patients with high severity (-2,00 vs. -1.31). For patients with 3 or more high-risk variables, there was a modest, but s tatistically significant, tendency For reduced global improvement (endpoint CGI-I score of 2.7 for the high-risk vs. 2.4 for the non-high-risk group; p = .017), although the high-risk group actually had a similar endpoint red uction in frequency of panic attacks (82%) compared with the non-high-risk group (78%). Conclusion: Treatment of panic disorder with sertraline was generally effec tive, even in the presence of baseline clinical variables that have been as sociated with poor treatment response. The main limitations of the analysis were the reliance on pooled data from 4 studies (even if the designs were similar) and our inability to examine the impact of depression and personal ity disorders on response to treatment because of the exclusion criteria of the clinical trials.