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Signal Attenuation as a Rat Model of Obsessive Compulsive Disorder
Published on: January 9, 2015
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Systematic Review and Meta-Analysis of Individual Participant Data: Randomized, Placebo-Controlled Trials of
Sem E Cohen1, Anthonius de Boer2, Bram W C Storosum3
1Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands.
Journal of the American Academy of Child and Adolescent Psychiatry
|January 12, 2025
Summary
Selective serotonin reuptake inhibitors (SSRIs) show a small effect in treating pediatric obsessive-compulsive disorder (OCD). Baseline symptom severity negatively impacts treatment response, suggesting personalized approaches are needed for children with OCD.
Area of Science:
- Psychiatry and Behavioral Sciences
- Pharmacology and Therapeutics
- Clinical Epidemiology
Background:
- Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy for pediatric obsessive-compulsive disorder (OCD).
- Individual participant data (IPD) meta-analyses are crucial for identifying patient-level effect modifiers in pediatric OCD treatment.
- Previous SSRI trials in pediatric OCD have not utilized IPD for comprehensive efficacy and modifier analysis.
Purpose of the Study:
- To conduct an IPD meta-analysis on the efficacy of SSRIs compared to placebo in children and adolescents with OCD.
- To perform a meta-regression examining baseline patient characteristics as potential modifiers of SSRI efficacy.
- To assess the impact of factors like age, sex, weight, illness duration, family history, and symptom severity on treatment response.
Main Methods:
- Collected crude participant data from randomized, placebo-controlled SSRI trials for pediatric OCD.
- Conducted a 1- and 2-stage IPD meta-analysis using Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) change and responder rates (≥35% CY-BOCS reduction).
- Examined potential modifiers of efficacy and assessed methodological rigor using Cochrane RoB 2.0 and GRADE criteria.
Main Results:
- Meta-analysis of 614 patients from 4 studies revealed a small effect size for SSRIs (0.38 Hedges' g) with a mean CY-BOCS reduction of 3.0 points.
- Responder analysis showed an odds ratio of 1.89 for SSRI response compared to placebo.
- Baseline symptom severity was a significant negative modifier of treatment response (β = -0.92, p = .0074).
Conclusions:
- SSRIs demonstrate a small overall effect size in treating pediatric OCD.
- Higher baseline symptom severity is associated with a lower likelihood of response to SSRIs.
- Generalizability may be limited due to the overrepresentation of White, North American participants in the included trials.
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