A Cochrane review [Abstract] 1 included 36 studies with a total of 5908 subjects. 6 trials compared azapirones with placebo, and two trials compared azapirones with benzodiazepines (n=76). Participants were males and females of all ages, with possible concomitant depressive symptoms but without comorbid substance misuse or recent use of benzodiazepines. The duration of the active treatment versus placebo phases ranged from four to 14 weeks. In these studies, azapirones (buspirone, gepirone or ipsapirone) were compared to placebo, benzodiazepines, antidepressants, psychotherapy or kava kava (a herbal remedy). Azapirones (buspirone or gepirone), were superior to placebo in treating GAD (total n=187, RR for improvement on the Clinical Global Impression scale 1.74, 95% CI 1.21 to 2.5, NNT 4.4, 95% CI 2.16 to 15.4). 2 out of 3 small studies (total n=111) showed superiority of buspirone over placebo for improvement in the Hamilton Anxiety Scale. One trial (n=365) comparing buspirone with venlafaxine showed no significant difference. Significantly fewer participants dropped out on azapirones compared to placebo, but in comparison with benzodiazepines, the drop-out rate was higher for those on azapirones (RR 1.30 95% CI 1.01 to 1.79).
Comment: The quality of evidence is downgraded by sparse data, and there was also slight inconsistency in the results. As the long term use of benzodiazepines is associated with physical dependency, the higher drop-out rate in then azapirone groups has pros and cons. Azapirones do not present abuse potential or withdrawal symptoms.
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