An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis.
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Ramakrishnan Divya, Farhat Luis C, Vattimo Edoardo F Q, Levine Jessica L S, Johnson Jessica A, Artukoglu Bekir B, Landeros-Weisenberger Angeli, Zangen Abraham, Pelissolo Antoine, de B Pereira Carlos A, Rück Christian, Costa Daniel L C, Mataix-Cols David, Shannahoff-Khalsa David, Tolin David F, Zarean Elham, Meyer Elisabeth, Hawken Emily R, Storch Eric A, Andersson Erik, Miguel Euripedes C, Maina Giuseppe, Leckman James F, Sarris Jerome, March John S, Diniz Juliana B, Kobak Kenneth, Mallet Luc, Vulink Nienke C C, Amiaz Revital, Fernandes Rodrigo Yacubian, Shavitt Roseli G, Wilhelm Sabine, Golshan Shahrokh, Tezenas du Montcel Sophie, Erzegovesi Stefano, Baruah Upasana, Greenberg William M, Kobayashi Yuki, Bloch Michael H
Аннотация
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.