An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Journal of Psychiatric Research Année : 2024

An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis

Elisabeth Meyer
Eric Storch
Erik Andersson
  • Fonction : Auteur
Kenneth Kobak
  • Fonction : Auteur
William Greenberg

Résumé

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.
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Dates et versions

hal-04547493 , version 1 (15-04-2024)

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Divya Ramakrishnan, Luis Farhat, Edoardo F.Q. Vattimo, Jessica L.S. Levine, Jessica Johnson, et al.. An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis. Journal of Psychiatric Research, 2024, 173, pp.387-397. ⟨10.1016/j.jpsychires.2024.03.044⟩. ⟨hal-04547493⟩
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