In this episode, we look at a large, prominent trial that found no effect of prazosin on PTSD symptoms or sleep quality in veterans with a history of combat trauma. Why didn't this study find benefit from prazosin treatment, when many others had? And if so many other trials found benefit, why do this study anyway? . We get excited talking about inclusion criteria, and we say equipoise many, many times. The article we discuss is part of the ABPN MOC; none of the podcast authors are associated with the MOC, and we have no knowledge of the questions.
The article we discuss is MA Raskind et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. New England Journal of Medicine 2018; 378(6):507-517
For an example of an earlier study that DID find benefit of prazosin for PTSD, check out Raskind, MA et al. A Trial of Prazosin for Combat Trauma PTSD with Nightmares in Active-Duty Soldiers Returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170: 1003-1010.
Recent meta-analyses of the efficacy of prazosin for PTSD can be found here and here.
A brief review on the ethical principles of equipoise in research.