Publication: Systematic Review and Meta-Analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder
Authors
Farhat, Luis C. ; Vattimo, Edoardo F. Q. ; Ramakrishnan, Divya ; Levine, Jessica L.S. ; Johnson, Jessica A. ; Artukoglu, Bekir B. ; Landeros-Weisenberger, Angeli ; Asbahr, Fernando R. ; Cepeda, Sandra L. ; Comer, Jonathan S. ; Fatori, Daniel ; Franklin, Martin E. ; Freeman, Jennifer B. ; Geller, Daniel A. ; Goodman, Wayne K. ; Heyman, Isobel ; Ivarsson, Tord ; Lenhard, Fabian ; Lewin, Adam B. ; Li, Fenghua ; Merlo, Lisa J. ; Mohsenabadi, Hamid ; Peris, Tara S. ; Piacentini, John ; Rosa-Alcázar, Ana Isabel ; Rosa-Alcázar, Ángel ; Rozenman, Michelle ; Sapyta, Jeffrey J. ; Serlachius, Eva ; Shabani, Mohammad J. ; Shavitt, Roseli G. ; Small, Brent J. ; Skarphedinsson, Gudmundur ; Swedo, Susan E. ; Thomsen, Per Hove ; Turner, Cynthia ; Weidle, Bernhard ; Euripides C., Miguel ; Storch, Eric A. ; Mataix-Cols, David ; Bloch, Michael H. ; Grant, Paul J.
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Publisher
Elsevier
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DOI
https://doi.org/10.1016/j.jaac.2021.05.027
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info:eu-repo/semantics/article
Description
©<2022>. This manuscript version is made available under the CC-BY-NC 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
This document is the, Submitted, version of a Published Work that appeared in final form in Journal of the American Academy of Child and Adolescent Psychiatry. To access the final edited and published work see: https://doi.org/10.1016/j.jaac.2021.05.027
Abstract
Objective: A lack of universal definitions for response and remission in pediatric obsessive- compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes.
Method: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references, 42 randomized controlled clinical trials (RCTs) were considered eligible and 21 provided data for inclusion (N 1,234). A score ≤ 2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A two-stage random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. Results: The CY-BOCS had sufficient discriminative ability to determine response (AUC 0.89) and remission (AUC 0.92). The optimal cutoff for response was a ≥ 35% reduction from baseline to posttreatment (sensitivity [95% CI] 83.9 [83.7, 84.1]; specificity [95% CI] 81.7 [81.5, 81.9]). The optimal cutoff for remission was a posttreatment raw score ≤ 12 (sensitivity [95% CI] 82.0 [81.8, 82.2]; specificity [95% CI] 84.6 [84.4, 84.8]). Conclusion: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD RCTs. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
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Citation
Journal of the American Academy of Child & Adolescent Psychiatry
Volume 61, Issue 4, April 2022, Pages 495-507
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Este ítem está sujeto a una licencia Creative Commons. http://creativecommons.org/licenses/by-nc-nd/4.0/