2.1Venlafaxine for GAD

Quality assessmentSummary of findingsImportance
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsVenlafaxinecontrolRelative (95% CI)Absolute
HAM-A - Venlafaxine 75mg vs 150mg (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none8787-MD 1.5 lower (3.15 lower to 0.15 higher)⊕⊕⊕○
MODERATE
Non Response - Venlafaxine 75mg vs 150mg
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none122/278 (43.9%)48.2%RR 0.93 (0.78 to 1.12)34 fewer per 1000 (from 106 fewer to 58 more)⊕⊕⊕○
MODERATE
Discontinuation due to Adverse Events - Venlafaxine 37.5mg vs 75mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none11/141 (7.8%)12.7%RR 0.61 to 1.26)50 fewer per 1000 (0.3 (from 89 fewer to 33 more)⊕⊕⊕○
MODERATE
Discontinuation due to Adverse Events - Venlafaxine 75mg vs 150mg
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none34/325 (10.5%)12.3%RR 0.85 (0.55 to 1.32)18 fewer per 1000 (from 55 fewer to 39 more)⊕⊕⊕○
MODERATE
Nausea - Venlafaxine 37.5mg vs 75mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone31/140 (22.1%)34.3%RR 0.65 (0.44 to 0.95)120 fewer per 1000 (from 17 fewer to 192 fewer)⊕⊕⊕⊕
HIGH
Nausea - Venlafaxine 75mg vs 150mg
3randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone120/328 (36.6%)43.6%RR 0.82 (0.68 to 0.98)78 fewer per 1000 (from 9 fewer to 140 fewer)⊕⊕⊕⊕
HIGH
Nausea - Venlafaxine 150mg vs 225mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none46/91 (50.5%)46.7%RR 1.08 (0.8 to 1.46)37 more per 1000 (from 93 fewer to 215 more)⊕⊕⊕○
MODERATE
Insomnia - Venlafaxine 75mg vs 150mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone16/92 (17.4%)29.7%RR 0.59 (0.34 to 1.01)122 fewer per 1000 (from 196 fewer to 3 more)⊕⊕⊕⊕
HIGH
Insomnia - Venlafaxine 150mg vs 225mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none27/91 (29.7%)31.1%RR 0.95 (0.61 to 1.48)16 fewer per 1000 (from 121 fewer to 149 more)⊕⊕⊕○
MODERATE
Nervousness - Venlafaxine 75mg vs 150mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none10/92 (10.9%)17.6%RR 0.62 (0.3 to 1.29)67 fewer per 1000 (from 123 fewer to 51 more)⊕⊕⊕○
MODERATE
Nervousness - Venlafaxine 150mg vs 225mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none16/91 (17.6%)10%RR 1.76 (0.82 to 3.77)76 more per 1000 (from 18 fewer to 277 more)⊕⊕⊕○
MODERATE
Dizziness - Venlafaxine 37.5mg vs 75mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none21/140 (15%)21.6%RR 0.69 (0.42 to 1.15)67 fewer per 1000 (from 125 fewer to 32 more)⊕⊕⊕○
MODERATE
Dizziness - Venlafaxine 75mg vs 150mg
3randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none70/328 (21.3%)22%RR 0.82 (0.56 to 1.2)40 fewer per 1000 (from 97 fewer to 44 more)⊕⊕⊕○
MODERATE
Dizziness - Venlafaxine 150mg vs 225mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone20/91 (22%)7.6%RR 2.91 (1.6 to 5.29)145 more per 1000 (from 46 more to 326 more)⊕⊕⊕⊕
HIGH
Asthenia - Venlafaxine 75mg vs 150mg
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none24/194 (12.4%)17.5%RR 0.7 (0.43 to 1.13)53 fewer per 1000 (from 100 fewer to 23 more)⊕⊕⊕○
MODERATE
Asthenia - Venlafaxine 150mg vs 225mg
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none12/91 (13.2%)21.1%RR 0.62 (0.32 to 1.21)80 fewer per 1000 (from 143 fewer to 44 more)⊕⊕⊕○
MODERATE
1

Wide confidence interval

2

No explanation was provided

From: Appendix 18, GRADE evidence profiles

Cover of Generalised Anxiety Disorder in Adults
Generalised Anxiety Disorder in Adults: Management in Primary, Secondary and Community Care.
NICE Clinical Guidelines, No. 113.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2011.
Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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