TY - JOUR
T1 - An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder
T2 - a systematic review and individual-patient data meta-analysis
AU - Ramakrishnan, Divya
AU - Farhat, Luis C.
AU - Vattimo, Edoardo F.Q.
AU - Levine, Jessica L.S.
AU - Johnson, Jessica A.
AU - Artukoglu, Bekir B.
AU - Landeros-Weisenberger, Angeli
AU - Zangen, Abraham
AU - Pelissolo, Antoine
AU - Carlos, Carlos A.
AU - Rück, Christian
AU - Costa, Daniel L.C.
AU - Mataix-Cols, David
AU - Shannahoff-Khalsa, David
AU - Tolin, David F.
AU - Zarean, Elham
AU - Meyer, Elisabeth
AU - Hawken, Emily R.
AU - Storch, Eric A.
AU - Andersson, Erik
AU - Miguel, Euripedes C.
AU - Maina, Giuseppe
AU - Leckman, James F.
AU - Sarris, Jerome
AU - March, John S.
AU - Diniz, Juliana B.
AU - Kobak, Kenneth
AU - Mallet, Luc
AU - Vulink, Nienke C.C.
AU - Amiaz, Revital
AU - Fernandes, Rodrigo Yacubian
AU - Shavitt, Roseli G.
AU - Wilhelm, Sabine
AU - Golshan, Shahrokh
AU - Tezenas du Montcel, Sophie
AU - Erzegovesi, Stefano
AU - Baruah, Upasana
AU - Greenberg, William M.
AU - Kobayashi, Yuki
AU - Bloch, Michael H.
N1 - Publisher Copyright: © 2024 Elsevier Ltd
PY - 2024/5
Y1 - 2024/5
N2 - Introduction: Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. Methods: We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. Results: Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. Conclusion: While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.
AB - Introduction: Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. Methods: We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. Results: Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. Conclusion: While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.
KW - Clinical trials
KW - Meta analysis
KW - Obsessive compulsive disorder
KW - Statistical analysis
KW - Systematic review
KW - Threshold determination
UR - http://www.scopus.com/inward/record.url?scp=85189765414&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychires.2024.03.044
DO - 10.1016/j.jpsychires.2024.03.044
M3 - Article
C2 - 38598877
AN - SCOPUS:85189765414
SN - 0022-3956
VL - 173
SP - 387
EP - 397
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
ER -