title: Time to response in panic disorder in a naturalistic setting: combination therapy with alprazolam orally disintegrating tablets and serotonin reuptake inhibitors compared to serotonin reuptake inhibitors alone.
abstract: OBJECTIVE
  This study evaluated time to response in the treatment of panic disorder with a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) combined with alprazolam orally disintegrating tablets (ODT), or SSRI/SNRI alone.
  
  
  METHODS
  Subjects were randomized to eight weeks open-label treatment with alprazolam ODT (4 weeks treatment followed by 3-4 week taper) combined with an SSRI or SNRI, or treatment with SSRI/SNRI alone.
  
  
  METHODS
  The study was conducted under naturalistic conditions at 62 primary care and 34 psychiatric practices.
  
  
  METHODS
  Male or female subjects ≥18 years of age diagnosed with panic disorder, with or without agoraphobia.
  
  
  METHODS
  The primary efficacy measure was time to response, defined as ≥50-percent decrease from baseline Hamilton Rating Scale for Anxiety (HAM-A) total score. Secondary measures included change from baseline in HAM-A scores and the Clinical Global Impression of Improvement (CGI-I) and Patient Global Impression (PGI) scales.
  
  
  RESULTS
  The intent-to-treat (ITT) population comprised 245 subjects. There was no statistical difference between treatment groups in time to response in the ITT population; however, a prospectively defined per protocol analysis revealed a statistically significant earlier onset of effect in subjects receiving SSRI/SNRI plus alprazolam ODT (P<0.05). Mean change from baseline in HAM-A total score and clinician and patient measures of global improvement also showed statistically significant early advantages for combination therapy compared with SSRI/SNRI monotherapy.
  
  
  CONCLUSIONS
  Combined treatment of panic disorder with alprazolam ODT and an SSRI/SNRI may be associated with more rapid improvement in anxiety symptoms compared with an SSRI/SNRI alone.
authors.affiliation: Dr. Katzelnick is from Healthcare Technology Systems, Inc. and is Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: David J
authors.initials: DJ
authors.lastname: Katzelnick
authors.forename: Johnaqa
authors.initials: J
authors.lastname: Saidi
authors.forename: Mark R
authors.initials: MR
authors.lastname: Vanelli
authors.forename: James W
authors.initials: JW
authors.lastname: Jefferson
authors.forename: James M
authors.initials: JM
authors.lastname: Harper
authors.forename: Kay E
authors.initials: KE
authors.lastname: McCrary