Augmentation agents to serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder: A network meta-analysis

Zhou, Dongdong; Zhou, Xiaoxin; Li, Yao; Zhang, Kaifu; Lv, Zhen; Chen, Xiaorong; Wan, Liyang; Wang, Wo; Wang, Gao-Mao; Li, Daqi; Ai, Ming; Kuang, Li

doi:10.1016/j.pnpbp.2018.12.009

Cited by 30 publications

(22 citation statements)

References 58 publications

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“…Many studies indicated topiramate could be used for the OCD, especially for the Treatment-Resistant OCD (Van Ameringen et al 2006;Mowla et al 2010;Berlin et al 2011;Afshar et al 2014). Recently, a metaanalysis provided confirmed evidence that topiramate can be used as an augmentation drug for treatment-resistant compulsive disorders (Zhou et al 2019). Obsessive-compulsive symptoms are frequently associated with TDs (Rothenberger and Roessner 2019).…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Efficacy and Tolerability of Topiramate for Tic Disorders: A Meta-Analysis

Yan

Wen

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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Background: Tic disorders (TDs) are chronic neuropsychiatric disorders that usually begin in childhood. Currently, antipsychotic drugs, such as aripiprazole and risperidone, are frequently used to treat TD. However, adverse reactions limit their further usage. The efficacy of topiramate has been reported in recent studies. This study aimed to investigate the efficacy and tolerability of topiramate in the treatment of children with TDs. Methods: In this study, we performed a meta-analysis to assess the efficacy and tolerability of topiramate for TDs and identified the randomized controlled trials to evaluate topiramate for children with TDs from PubMed, the China National Knowledge Infrastructure database, Web of Science, and relevant reference lists. Quality assessment followed the Cochrane Handbook for Systematic Reviews of Interventions. A modified Jadad scale was used to assess the quality of included studies. Risk ratio (RR) was calculated as the effect size of efficacy and tolerability of topiramate for TDs. Results: A total of 15 studies involving 1070 participants aged 2-17 were included in the present meta-analysis, and 693 (64.71%) participants were male cases, with 14 studies evaluating the efficacy of topiramate for the treatment of TD. The results suggested that topiramate was more effective than control drugs (RR: 1.13, 95% confidence interval: [1.06-1.20], I 2 = 36%, Q = 20.31, p = 0.09). For the adverse events, there were 15 trials included in the meta-analysis, and the results showed that topiramate had fewer adverse events than control drugs (RR: 0.54, 95% confidence interval: [0.46-0.65], I 2 = 45%, Q = 25.49, p = 0.03). Conclusion: Compared with haloperidol and tiapride, topiramate appears to be a promising medication with good efficacy and tolerability for children with TDs. In future studies, large-sample, double-blind, placebo-controlled trials are needed to confirm its efficacy and tolerability compared with atypical antipsychotic agents (such as risperidone or aripiprazole).

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Section: Discussionmentioning

confidence: 99%

Revisiting the Efficacy and Tolerability of Topiramate for Tic Disorders: A Meta-Analysis

Yan

Wen

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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“…Interest in antipsychotic augmentation of SSRIs stems from the dopaminergic overactivation theory in OCD, and they are recommended as the first-line augmenting agents in OCD. Several meta-analyses [16][17][18] have concluded that antipsychotics are effective augmentation agents, but they differ in their conclusion as to which of them are effective and how effective they are. Two influential meta-analyses concluded that aripiprazole and risperidone significantly outperform placebo [16,17], but the study by Veale et al was very cautious in its recommendation of antipsychotics as augmenting agents because of small effect sizes and long-term side effects.…”

Section: Is Antipsychotic Augmentation Of Ssris Effective?mentioning

confidence: 99%

“…The study could not recommend which drugs are most effective because of limited number of studies and heterogeneity across studies. Interestingly, they found quetiapine and olanzapine to be significantly superior to placebo, but risperidone lost significance after adjusting for baseline symptom severity [18]. Enthusiasm in the efficacy of antipsychotics as augmenting agents is dampened to an extent because of the superiority of CBT over risperidone and pill placebo in a randomized clinical trial that compared the efficacy of CBT vs. risperidone for augmenting SSRIs [19].…”

Section: Is Antipsychotic Augmentation Of Ssris Effective?mentioning

confidence: 99%

“…The literature on the efficacy of glutamate-modulating drugs is limited, and studies have mostly small sample sizes [23]. A recent network meta-analysis found memantine, topiramate, and lamotrigine to be significantly superior to placebo [18]. Despite some inconsistent evidence [24], memantine [18] and N-acetylcysteine [25] have the best evidence base as augmenting agents.…”

Section: Glutamate-modulating Drugs As Potential Therapeutic Optionsmentioning

confidence: 99%

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Are current pharmacotherapeutic strategies effective in treating OCD?

Reddy

Arumugham

2020

Expert Opinion on Pharmacotherapy

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“…The most effective strategies in treatment of resistant OCD are the addition of antipsychotics to SSRIs; addition of CBT to current medications, and adding glutamergic agents to the current treatment. 7,8 In a comparative clinical trial on resistant OCD patients, 27.27% of the cases in the aripiprazole group and 54.54% of those in the quetiapine cluster responded moderately to the augmentation. 9 A study of risperidone augmentation in resistant OCD patients found that 40% of the patients were responsive to the augmentation.…”

Section: Introductionmentioning

confidence: 99%

Pregabalin augmentation for resistant obsessive–compulsive disorder: a double-blind placebo-controlled clinical trial

Mowla

Ghaedsharaf

2019

CNS Spectr.

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Background and objective.Glutamate dysfunction has been shown to be associated with pathophysiology of obsessive–compulsive disorder (OCD). Our objective is to survey the effects of pregabalin (a glutamate-modulating agent) as an augmenting treatment for resistant OCD.Patients and methods.In this 12-week double-blind placebo-controlled clinical trial, 56 patients with resistant OCD were randomly allocated to receive either pregabalin or placebo plus their current medication (sertraline). Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the outcomes. Adverse effects were also registered.Results.Of the 56 patients with resistant OCD who were randomly allocated in 2 groups of pregabalin (n = 28) and placebo group (n = 28), 42 patients (22 in pregabalin group and 20 in placebo group) completed the trial. Throughout the trial, the mean score decreased from 26.13± 7.03 to 8.81 ± 3.47 in the pregabalin group (p < 0) and from 26.85 ± 4.34 to 17.63 ± 4.22 in the placebo group (p < 0). At the end of trial, 16 (57.14%) patients in the pregabalin group and 2 (7.14%) patients in the placebo group showed more than 35% decline in YBOCS (p < .01). The pregabalin group showed good tolerability and safety.Conclusions.Our study revealed that pregabalin, as an augmenting medication, is more effective than placebo in the treatment of patients with resistant OCD.

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Augmentation agents to serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder: A network meta-analysis

Cited by 30 publications

References 58 publications

Revisiting the Efficacy and Tolerability of Topiramate for Tic Disorders: A Meta-Analysis

Revisiting the Efficacy and Tolerability of Topiramate for Tic Disorders: A Meta-Analysis

Are current pharmacotherapeutic strategies effective in treating OCD?

Pregabalin augmentation for resistant obsessive–compulsive disorder: a double-blind placebo-controlled clinical trial

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