Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder.
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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, Grant Paul J, 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 I, Rosa-Alcázar Àngel, 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, Miguel Euripedes C, Storch Eric A, Mataix-Cols David, Bloch Michael H
Аннотация
METHOD: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-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 = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8).
CONCLUSION: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.