Predictors of Response to Prolonged Exposure, Sertraline, and Their Combination for the Treatment of Military PTSD
- PMID: 34133087
- DOI: 10.4088/JCP.20m13752
Predictors of Response to Prolonged Exposure, Sertraline, and Their Combination for the Treatment of Military PTSD
Abstract
Objective: The current study is an analysis of predictors of posttraumatic stress disorder (PTSD) treatment response in a clinical trial comparing (1) prolonged exposure plus placebo (PE + PLB), (2) PE + sertraline (PE + SERT), and (3) sertraline + enhanced medication management (SERT + EMM) with predictors including time since trauma (TST), self-report of pain, alcohol use, baseline symptoms, and demographics.
Methods: Participants (N = 196) were veterans with combat-related PTSD (DSM-IV-TR) of at least 3 months' duration recruited between 2012 and 2016 from 4 sites in the 24-week PROlonGed ExpoSure and Sertraline (PROGrESS) clinical trial (assessments at weeks 0 [intake], 6, 12, 24, 36, and 52).
Results: Across treatment conditions, (1) longer TST was predictive of greater week 24 PTSD symptom improvement (β = 1.72, P = .01) after adjusting for baseline, (2) higher baseline pain severity was predictive of smaller symptom improvement (β = -2.96, P = .003), and (3) Hispanic patients showed greater improvement than non-Hispanic patients (β = 12.33, P = .03). No other baseline characteristics, including alcohol consumption, were significantly predictive of week 24 improvement. Comparison of TST by treatment condition revealed a significant relationship only in those randomized to the PE + SERT condition (β = 2.53, P = .03). Longitudinal analyses showed similar results.
Conclusions: The finding that longer TST shows larger symptom reductions is promising for PTSD patients who might not seek help for years following trauma. Higher baseline pain severity robustly predicted attenuated and slower response to all treatment conditions, suggesting a common neuropathologic substrate. Finally, in the current study, alcohol use did not impede the effectiveness of pharmacotherapy for PTSD.
Trial Registration: ClinicalTrials.gov identifier: NCT01524133.
© Copyright 2021 Physicians Postgraduate Press, Inc.
Similar articles
-
Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial.JAMA Psychiatry. 2019 Feb 1;76(2):117-126. doi: 10.1001/jamapsychiatry.2018.3412. JAMA Psychiatry. 2019. PMID: 30516797 Free PMC article. Clinical Trial.
-
Reductions in guilt cognitions following prolonged exposure and/or sertraline predict subsequent improvements in PTSD and depression.J Behav Ther Exp Psychiatry. 2021 Jun 1;73:101666. doi: 10.1016/j.jbtep.2021.101666. Online ahead of print. J Behav Ther Exp Psychiatry. 2021. PMID: 34147766
-
Integrating biological treatment mechanisms into randomized clinical trials: Design of PROGrESS (PROlonGed ExpoSure and Sertraline Trial).Contemp Clin Trials. 2018 Jan;64:128-138. doi: 10.1016/j.cct.2017.10.013. Epub 2017 Oct 29. Contemp Clin Trials. 2018. PMID: 29081351 Clinical Trial.
-
Pharmacotherapy for anxiety and comorbid alcohol use disorders.Cochrane Database Syst Rev. 2015 Jan 20;1:CD007505. doi: 10.1002/14651858.CD007505.pub2. Cochrane Database Syst Rev. 2015. PMID: 25601826 Review.
-
Novel Augmentation Strategies in Major Depression.Dan Med J. 2017 Apr;64(4):B5338. Dan Med J. 2017. PMID: 28385173 Review.
Associated data
LinkOut - more resources
Full Text Sources
Medical