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 PTSD treatment response in a clinical trial comparing: 1) prolonged exposure plus placebo (PE + PLB); 2) PE + sertraline (PE + SERT); and 3) SERT + 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 of at least three months duration recruited between 2011 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 – (i) Longer TST was predictive of greater week 24 PTSD symptom improvement after adjusting for baseline; (ii) Higher baseline pain severity was predictive of smaller symptom improvement and; (iii) Hispanics showed greater improvement than non-Hispanics. 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 PE+SERT condition. 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 neuropathological substrate. Finally, in the current study alcohol use did not impede the effectiveness pharmacotherapy for PTSD. Trial Registration: ClinicalTrials.gov: NCT01524133