Meta-Analysis Forest Plots

Valerie Forman-Hoffman; Jennifer Cook Middleton; Cynthia Feltner; Bradley N. Gaynes; Rachel Palmieri Weber; Carla Bann; Meera Viswanathan; Kathleen N. Lohr; Claire Baker; Joshua Green

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Forman-Hoffman V, Middleton JC, Feltner C, et al. Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 May. (Comparative Effectiveness Review, No. 207.)

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Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update [Internet].

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Appendix HMeta-Analysis Forest Plots

Key Question 1

CBT-Mixed: Meta-Analysis Results

Figure H-1 is titled “Standardized mean change in baseline in PTSD symptoms (CAPS, PSS-I, IES, PCL, PDS) for CBT-mixed compared with inactive comparators.” This figure displays a forest plot reporting the standardized mean difference of PTSD symptoms, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in PTSD symptoms for patients treated with CBT-mixed interventions than patients treated with inactive comparators (21 trials, standardized mean difference −0.99, 95% CI −1.25 to −0.73, I2 =80.5%).

Figure H-1Standardized mean change from baseline in PTSD symptoms (CAPS, PSS-I, IES, PCL, PDS) for CBT-mixed compared with inactive comparators

Figure H-2 is titled “Standardized mean change from baseline in CAPS for CBT-mixed compared with inactive comparators at 3 to 6 months.” This figure displays a forest plot reporting the standardized mean difference in CAPS at 3 to 6 months, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in CAPS scores for patients treated with CBT-mixed interventions than patients treated with inactive comparators (3 trials, standardized mean difference −0.82, 95% CI −1.85 to 0.22).

Figure H-2Standardized mean change from baseline in CAPS for CBT-mixed compared with inactive comparators at 3 to 6-month followup

Figure H-3 is titled “Standardized mean change from baseline in PTSD symptoms for CBT-mixed compared with inactive comparators at 3 to 6-month follow-up.” The figure displays a forest plot reporting the standardized mean difference in PTSD symptoms, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in PTSD symptoms at 3 to 6 months for patients treated with CBT-mixed interventions than patients treated with inactive comparators (6 trials, standardized mean difference −0.74, 95% CI −1.29 to −0.19).

Figure H-3Standardized mean change from baseline in PTSD symptoms for CBT-mixed compared with inactive comparators at 3 to 6-month followup

Figure H-4 is titled “Standardized mean change from baseline in depressive symptoms (measured by BDI) for CBT-mixed compared with inactive comparators.” The figure displays a forest plot reporting standardized mean difference of BDI scores, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in BDI scores for patients treated with CBT-mixed interventions than patients treated with inactive comparators (15 trials, standardized mean difference −0.87, 95% CI −1.14 to −0.61, I2= 72.0%).

Figure H-4Standardized mean change from baseline in depressive symptoms (measured by BDI) for CBT-mixed compared with inactive comparators

Figure H-5 is titled “Standardized mean change from baseline in depressive symptoms (measured by BDI) for CBT-mixed compared with inactive comparators at 3 to 6-months.” The figure displays a forest plot reporting standardized mean difference of BDI scores, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in BDI scores for patients treated with CBT-mixed interventions than patients treated with inactive comparators (5 trials, standardized mean difference −0.55, 95% CI −0.78 to −0.31).

Figure H-5Standardized mean change from baseline in depressive symptoms (measured by BDI) for CBT-mixed compared with inactive comparators at 3 to 6-months

Figure H-6 is titled “Standardized mean change from baseline in anxiety symptoms (measured by STAI) for CBT-mixed compared with inactive comparators.” The figure displays a forest plot reporting standardized mean difference of STAI scores, CBT-mixed compared to inactive comparators. The plot depicts greater reductions in STAI scores for patients treated with CBT-mixed interventions than patients treated with inactive comparators (5 trials, standardized mean difference −0.79, 95% CI −1.31 to −0.27).

Figure H-6Standardized mean change from baseline in anxiety symptoms (measured by STAI) for CBT-mixed compared with inactive comparators

Key Question 2

Alpha-Blockers: Meta-Analysis Results

Figure H-7 is titled “Standardized mean change from baseline in CAPS for prazosin compared with placebo.” The figure displays a forest plot reporting standardized mean difference of CAPS scores, prazosin compared to placebo. The plot depicts greater reductions in CAPS scores for patients treated with alpha blockers than patients treated with placebo (3 trials, standardized mean difference −0.52, 95% CI −0.90 to −0.14).

Figure H-7Standardized mean change from baseline in CAPS for prazosin compared with placebo

SNRIs: Meta-Analysis Results

Figure H-8 is titled “Standardized mean change from baseline in CAPS for venlafaxine compared with placebo.” The figure displays a forest plot reporting standardized mean difference of CAPS scores in two trials. Both trials favored venlafaxine at the end of treatment (2 trials, standardized mean difference range −0.26 to −0.35).

Figure H-8Standardized mean difference from baseline in CAPS for venlafaxine compared with placebo

Figure H-9 is titled “PTSD remission for venlafaxine compared with placebo.” The figure displays a forest plot reporting the risk difference of PTSD remission for patients treated with venlafaxine versus placebo. Both trials favored placebo at the end of treatment (2 trials, risk difference range 0.10 to 0.15).

Figure H-9PTSD remission for venlafaxine compared with placebo

Key Question 4

Withdrawals Due to Adverse Events: Meta-Analysis Results

Figure H-10 is titled “Withdrawals due to adverse events for anticonvulsants compared with placebo.” The figure displays a forest plot reporting the risk difference of withdrawals due to adverse events, stratified by divalproex compared with placebo, tiagabine compared with placebo, and topiramate compared with placebo. No significant differences in withdrawals rates were found between anticonvulsants and placebo overall (5 trials, risk difference 0.02, 95% CI −0.03 to 0.06, I2 = 0.0%).

Figure H-10Withdrawals due to adverse events for anticonvulsants compared with placebo

Figure H-11 is titled “Withdrawals due to adverse events for antipsychotics compared with placebo.” The figure displays a forest plot reporting the risk difference of withdrawals due to adverse events, stratified by olanzapine compared with placebo and risperidone compared with placebo. No significant differences in withdrawals rates were found between anticonvulsants and placebo overall (7 trials, risk difference 0.00, 95% CI −0.02 to 0.02, I2 = 0.0%).

Figure H-11Withdrawals due to adverse events for antipsychotics compared with placebo

Figure H-12 is titled “Withdrawals due to adverse events for SSRIs compared with placebo.” The figure displays a forest plot reporting the risk difference of withdrawals due to adverse events, stratified by fluoxetine compared with placebo, paroxetine compared with placebo, and sertraline compared with placebo. Overall there were higher rates of withdrawals due to placebo compared to SSRIs (13 trials, risk difference 0.02, 95% CI 0.00 to 0.04, I2 = 0.0%).

Figure H-12Withdrawals due to adverse events for SSRIs compared with placebo

Bookshelf ID: NBK525117

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