An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis
Divya Ramakrishnan
(1)
,
Luis Farhat
(2)
,
Edoardo F.Q. Vattimo
(2)
,
Jessica L.S. Levine
(1)
,
Jessica Johnson
(1)
,
Bekir Artukoglu
(3)
,
Angeli Landeros-Weisenberger
(1)
,
Abraham Zangen
(4)
,
Antoine Pelissolo
(5, 6)
,
Carlos de B. Pereira
(2)
,
Christian Rück
(7)
,
Daniel L.C. Costa
(2)
,
David Mataix-Cols
(7)
,
David Shannahoff-Khalsa
(8)
,
David Tolin
(1)
,
Elham Zarean
(9)
,
Elisabeth Meyer
(10)
,
Emily Hawken
(11)
,
Eric Storch
(3)
,
Erik Andersson
(12)
,
Euripedes Miguel
(2)
,
Giuseppe Maina
(13)
,
James Leckman
(14)
,
Jerome Sarris
(15)
,
John March
(16)
,
Juliana Diniz
(2)
,
Kenneth Kobak
,
Luc Mallet
(17, 18)
,
Nienke C.C. Vulink
(19)
,
Revital Amiaz
(20)
,
Rodrigo Yacubian Fernandes
(21)
,
Roseli Shavitt
(2)
,
Sabine Wilhelm
(21)
,
Shahrokh Golshan
(8)
,
Sophie Tezenas Du Montcel
(22)
,
Stefano Erzegovesi
(23)
,
Upasana Baruah
(24)
,
William Greenberg
(25)
,
Yuki Kobayashi
(26)
,
Michael Bloch
(1)
1
YSM -
Yale School of Medicine [New Haven, Connecticut]
2 USP - Universidade de São Paulo = University of São Paulo
3 BCM - Baylor College of Medicine
4 BGU - Ben-Gurion University of the Negev
5 U955 Inserm - UPEC - IMRB - "Neuropsychiatrie translationnelle" [Créteil]
6 CHU Henri Mondor [Créteil]
7 Karolinska Institute
8 UC San Diego - University of California [San Diego]
9 Shahrekord University
10 UFRGS - Federal University of Rio Grande do Sul
11 Queen's University [Kingston, Canada]
12 Lund University
13 UNITO - Università degli studi di Torino = University of Turin
14 Yale University [New Haven]
15 University of Melbourne
16 Duke University School of Medicine [Durham, NC, USA]
17 ICM - Institut du Cerveau = Paris Brain Institute
18 Hôpital Henri Mondor
19 UMCU - University Medical Center [Utrecht]
20 Chaim Sheba Medical Center
21 Massachusetts General Hospital [Boston]
22 ARAMIS - Algorithms, models and methods for images and signals of the human brain = Algorithmes, modèles et méthodes pour les images et les signaux du cerveau humain [ICM Paris]
23 IRCCS Ospedale San Raffaele [Milan, Italy]
24 National Institute of Mental Health and Neurosciences [Bagalore, India]
25 St. George's University [Grenada]
26 Keio University [Tokyo]
2 USP - Universidade de São Paulo = University of São Paulo
3 BCM - Baylor College of Medicine
4 BGU - Ben-Gurion University of the Negev
5 U955 Inserm - UPEC - IMRB - "Neuropsychiatrie translationnelle" [Créteil]
6 CHU Henri Mondor [Créteil]
7 Karolinska Institute
8 UC San Diego - University of California [San Diego]
9 Shahrekord University
10 UFRGS - Federal University of Rio Grande do Sul
11 Queen's University [Kingston, Canada]
12 Lund University
13 UNITO - Università degli studi di Torino = University of Turin
14 Yale University [New Haven]
15 University of Melbourne
16 Duke University School of Medicine [Durham, NC, USA]
17 ICM - Institut du Cerveau = Paris Brain Institute
18 Hôpital Henri Mondor
19 UMCU - University Medical Center [Utrecht]
20 Chaim Sheba Medical Center
21 Massachusetts General Hospital [Boston]
22 ARAMIS - Algorithms, models and methods for images and signals of the human brain = Algorithmes, modèles et méthodes pour les images et les signaux du cerveau humain [ICM Paris]
23 IRCCS Ospedale San Raffaele [Milan, Italy]
24 National Institute of Mental Health and Neurosciences [Bagalore, India]
25 St. George's University [Grenada]
26 Keio University [Tokyo]
Divya Ramakrishnan
- Fonction : Auteur
- PersonId : 1375242
- ORCID : 0000-0003-2581-1793
Luis Farhat
- Fonction : Auteur
- PersonId : 1334483
- ORCID : 0000-0002-3147-8344
Angeli Landeros-Weisenberger
- Fonction : Auteur
- PersonId : 1375243
- ORCID : 0000-0002-9556-6132
Daniel L.C. Costa
- Fonction : Auteur
- PersonId : 1375244
- ORCID : 0000-0001-7916-8567
Elisabeth Meyer
- Fonction : Auteur
- PersonId : 1375245
- ORCID : 0000-0001-8642-037X
Eric Storch
- Fonction : Auteur
- PersonId : 1375246
- ORCID : 0000-0002-7631-3703
Kenneth Kobak
- Fonction : Auteur
Roseli Shavitt
- Fonction : Auteur
- PersonId : 1375247
- ORCID : 0000-0001-5959-5748
Sophie Tezenas Du Montcel
- Fonction : Auteur
- PersonId : 754144
- IdHAL : sophie-tezenas-du-montcel
- ORCID : 0000-0002-2866-4330
- IdRef : 256276617
William Greenberg
- Fonction : Auteur
- PersonId : 1375248
- ORCID : 0000-0002-3507-8268
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.