Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric...

Area of Science:

• Child and Adolescent Psychiatry
• Clinical Psychology
• Psychometric Validation

Background:

• Lack of standardized definitions for treatment response and remission in pediatric obsessive-compulsive disorder (OCD) hinders cross-trial comparisons.
• The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is widely used but lacks empirically derived, universal cutoffs for these outcomes.

Purpose of the Study:

• To conduct a diagnostic test accuracy meta-analysis of the CY-BOCS in pediatric OCD.
• To evaluate the discriminative ability of the CY-BOCS for response and remission.
• To generate empirically derived optimal cutoffs for response and remission using the CY-BOCS.

Main Methods:

• Individual participant data meta-analysis of 21 randomized controlled trials (N=1,234) identified from a systematic review of four databases.
• Utilized Clinical Global Impressions Improvement and Severity scales scores (≤2) to define response and remission.
• Employed a two-stage, random-effects meta-analysis model, calculating Area Under the Curve (AUC) and Youden Index to assess discriminative ability and determine optimal cutoffs.

Main Results:

• The CY-BOCS demonstrated strong discriminative ability for response (AUC=0.89) and remission (AUC=0.92).
• Optimal cutoff for response: a ≥35% reduction from baseline (sensitivity=83.9%, specificity=81.7%).
• Optimal cutoff for remission: a posttreatment score ≤12 (sensitivity=82.0%, specificity=84.6%).

Conclusions:

• Empirically derived optimal cutoffs for the CY-BOCS have been identified for response and remission in pediatric OCD clinical trials.
• Standardized operational definitions using these CY-BOCS cutoffs will enhance the comparability and reliability of research findings in pediatric OCD treatment studies.