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

Farhat, Luis C.; Vattimo, Edoardo Filippo de Queiroz; Ramakrishnan, Divya; Levine, Jessica L.S.; Johnson, Jessica; Artukoğlu, Bekir B.; Landeros-Weisenberger, Angeli; Asbahr, Fernando Ramos; Cepeda, Sandra L.; Comer, Jonathan S.; Fatori, Daniel; Franklin, Martin E.; Freeman, Jennifer B.; Geller, Daniel; Grant, Paul; Goodman, Wayne K.; Heyman, Isobel; Ivarsson, Tord; Lenhard, Fabian; Lewin, Adam B.; Li, Fenghua; Merlo, Lisa J.; Mohsenabadi, Hamid; Peris, Tara S.; Piacentini, John; Alcázar, Ana Isabel Rosa; Rosa‐Alcázar, Ángel; Rozenman, Michelle; Sapyta, Jeffrey; Serlachius, Eva; Shabani, Mohammad; Shavitt, Roseli G.; Small, Brent J.; Skarphéðinsson, Guðmundur; Swedo, Susan E.; Thomsen, Per Hove; Turner, Cynthia; Weidle, Bernhard; Miguel, Eurí­pedes Constantino; Storch, Eric A.; Mataix‐Cols, David; Bloch, Michael H.

doi:10.1016/j.jaac.2021.05.027

Cited by 18 publications

(8 citation statements)

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“…To examine between condition differences in treatment response and remission, χ 2 ‐analyses were used. “Response” was a reduction of ≥35% on CY‐BOCS severity, whereas “remission” was a posttreatment or follow‐up CY‐BOCS of ≤12 (Farhat et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of D‐cycloserine augmented brief intensive cognitive‐behavioural therapy for paediatric obsessive‐compulsive disorder: A randomised clinical trial

Farrell

Waters

Tiralongo

et al. 2022

Depression and Anxiety

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Objective: To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes.Methods: Youth (n = 100, 7-17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions.Results: Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: −11.2 to −7.4, and estimate −10.7, 95% CI: −12.6 to −8.7), diagnostic severity (T1 to T2 estimate: −2.0, 95% CI: −2.4 to −1.5 and estimate −2.5, 95% CI: −3.0 to −2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1-and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs.Conclusions: DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample.

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Section: Methodsmentioning

confidence: 99%

“…"Response" was a reduction of ≥35% on CY-BOCS severity, whereas "remission" was a posttreatment or follow-up CY-BOCS of ≤12 (Farhat et al, 2021).…”

Section: Study Power and Analytic Planmentioning

confidence: 99%

Efficacy of D‐cycloserine augmented brief intensive cognitive‐behavioural therapy for paediatric obsessive‐compulsive disorder: A randomised clinical trial

Farrell

Waters

Tiralongo

et al. 2022

Depression and Anxiety

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“…At post-treatment, 57% of the sample were considered responders, and this was maintained at 2-month follow-up, with 63% of children meeting responder status. These response results are conservative estimates of response relative to earlier treatment outcome studies, with the most recent consensus on response being defined as ≥35% reduction in CY-BOCS severity ( Farhat et al, 2021 ) relative to earlier criteria which used ≥25% reduction.…”

Section: Discussionmentioning

confidence: 99%

“…In a more recent large RCT of d-Cycloserine augmented intensive ERP (three sessions of 3-h ERP) for pediatric OCD relative to placebo controlled intensive ERP ( n = 100, children 7 to 17 years), there were significant reductions in OCD severity and diagnostic severity, and improvements in functioning, for youth across both conditions following intensive ERP ( Farrell et al, 2022 ). At 6-month follow-up, between 69% and 74% of youth were responders (based on conservative responder criteria, Farhat et al, 2021 ) and 49%–51% were in remission following intensive ERP ( Farrell et al, 2022 ). Thus, there is good empirical support for brief, intensive ERP for pediatric OCD ( Storch et al, 2007 ; Whiteside et al, 2014 ; Riise et al, 2016 ; Canavera et al, 2022 ; Farrell et al, 2022 ), which could improve access to specialized treatment further if it could be delivered in even more efficient modalities, such as telehealth videoconferencing.…”

Section: Introductionmentioning

confidence: 99%

FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth

et al. 2022

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ObjectiveThe current study utilized a single case series, non-concurrent multiple baseline design to examine the efficacy of training parents via telehealth videoconferencing in exposure and response prevention (ERP) for home delivery of the treatment for their children and adolescents with obsessive compulsive disorder (OCD).MethodThere were nine participants aged 8 to 14 years who had received a primary diagnosis of OCD. The design involved a series of AB replications, whereby following pre-treatment assessments participants were randomly assigned to either a 2-week (n = 4) or 3-week (n = 5) baseline condition with weekly monitoring of their child’s OCD symptoms. Following baseline, parents participated four weekly telehealth parent-training modules in delivering FAST (Families Accessing Skills Training) cognitive behavior therapy (CBT) with ERP (CBT-ERP) to children with OCD via videoconferencing with the clinician. Primary outcome measures were OCD symptom severity, diagnostic severity, and global functioning, which were assessed post-treatment and at 2 month follow-up.ResultsThe stability of the baseline period from pre-treatment to week 2 (for the 2-week condition) or to week 3 (for the 3-week condition) was established as there were no significant differences across baseline scores for parent target obsessions or parent target compulsions ratings. Significant improvements on the primary outcomes of clinician assessed symptom severity, diagnostic ratings, and global functioning were observed from baseline to post-treatment, and continued to 2 months follow-up.ConclusionThese data suggest that brief, parent training in FAST CBT-ERP via telehealth provides an overall effective intervention that is likely to be of most benefit to children and youth who are mild to moderate in severity.

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“…After decades of inconsistent definitions of treatment response, remission, recovery, and relapse in clinical trials of obsessive-compulsive disorder (OCD), the field recently converged to endorse a set of conceptual and operational definitions [1]. These definitions have received additional empirical support [2] and are now widely used in clinical trials and regular practice; this has improved the comparability across treatment studies and communication between researchers, clinicians, and patients. However, an unexplored property of the definitions is their clinimetric sensitivity, which refers to the ability of a measure to identify clinically meaningful groups of patients [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life

Mataix‐Cols

Andersson

Aspvall

et al. 2022

Psychother Psychosom

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Introduction: The operational definitions of treatment response, partial response, and remission in obsessive-compulsive disorder (OCD) are widely used in clinical trials and regular practice. However, the clinimetric sensitivity of these definitions, that is, whether they identify patients that experience meaningful changes in their everyday life, remains unexplored. Objective: The objective was to examine the clinimetric sensitivity of the operational definitions of treatment response, partial response, and remission in children and adults with OCD. Methods: Pre- and post-treatment data from five clinical trials and three cohort studies of children and adults with OCD (n = 1,528; 55.3% children, 61.1% female) were pooled. We compared (1) responders, partial responders, and non-responders and (2) remitters and non-remitters on self-reported OCD symptoms, clinician-rated general functioning, and self-reported quality of life. Remission was also evaluated against post-treatment diagnostic interviews. Results: Responders and remitters experienced large improvements across validators. Responders had greater improvements than partial responders and non-responders on self-reported OCD symptoms (Cohen’s d 0.65–1.13), clinician-rated functioning (Cohen’s d 0.53–1.03), and self-reported quality of life (Cohen’s d 0.63–0.73). Few meaningful differences emerged between partial responders and non-responders. Remitters had better outcomes across most validators than non-remitters. Remission criteria corresponded well with absence of post-treatment diagnosis (sensitivity/specificity: 93%/83%). Using both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale yielded more conservative results and more robust changes across validators, compared to only using the Y-BOCS. Conclusions: The current definitions of treatment response and remission capture meaningful improvements in the everyday life of individuals with OCD, whereas the concept of partial response has dubious clinimetric sensitivity.

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

Cited by 18 publications

References 60 publications

Efficacy of D‐cycloserine augmented brief intensive cognitive‐behavioural therapy for paediatric obsessive‐compulsive disorder: A randomised clinical trial

Efficacy of D‐cycloserine augmented brief intensive cognitive‐behavioural therapy for paediatric obsessive‐compulsive disorder: A randomised clinical trial

FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth

Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life

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